Get Kyhealth Choices Prior Authorization Call Checklist - Chfs Ky

The KyHealth Choices Prior Authorization Call Checklist is a crucial document for efficiently requesting prior authorization for Medicaid services. Completing this form accurately ensures a smoother process in obtaining the necessary approvals for services.

Follow the steps to complete the checklist correctly.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling in the member's last name in the designated field. Ensure that the spelling is accurate.
3. Next, input the member's first name and middle initial. These fields must be completed for identification purposes.
4. Provide the member's full address, including the city and zip code. Accurate address information is essential.
5. Enter the member's Medicaid ID number in the required field.
6. Fill in the member's date of birth to verify eligibility.
7. If the member is under the age of 18, specify the responsible party's information.
8. Complete the ordering provider's name and their Medicaid number or license number if they are a non-Medicaid provider.
9. Enter the ordering provider contact person’s name and phone number for follow-up communications.
10. Provide the facility's name and address, ensuring all details are correct.
11. Input the facility's Medicaid number for identification in the system.
12. Fill in the facility contact person’s name and their phone number.
13. Specify the date(s) of service that are being requested in the appropriate field.
14. List the relevant diagnosis codes related to the services requested.
15. Provide the clinical criteria that support the need for the requested services.
16. Lastly, input the procedure codes associated with the requests.
17. Once all fields are completed, review the information for accuracy, then save changes, download, print, or share the form as necessary.

Complete the KyHealth Choices Prior Authorization Call Checklist online to streamline your prior authorization requests.