Follow the steps to complete the form thoroughly.

1. Press the ‘Get Form’ button to access the Priority Health Prior Authorization Form and open it in the designated editor.
2. Begin by filling out 'Member Information.' Enter the name, Priority Health ID number, plan type or product, and date of birth accurately.
3. Under 'Transfer from,' provide the previous setting details by indicating the hospital or facility name. Check the box if the admission is from the emergency department, observation, or home.
4. In the 'Admit to' section, record the admit date, SAR facility name, and the tax ID required for the facility.
5. Input the admitting diagnosis and ICD code, and check the box if it is a swing bed stay.
6. Complete the SAR facility information, including the address, city, zip code, contact name, phone number, and fax number.
7. Indicate the anticipated discharge date and the actual discharge date once the patient has been discharged.
8. Include any nursing notes if necessary, and ensure that all fields on both pages are filled out legibly and completely to avoid processing delays.
9. For concurrent reviews, ensure that the entire form is filled out. No additional documentation is required at this time.
10. Upon patient discharge, complete both pages again based on therapy discharge. Include therapy minutes log and discharge summary with the completed form.
11. Once all fields are completed accurately, users can save the changes, download the document, print it, or share it as needed.

Start filling out the Priority Health Prior Authorization Form online now for efficient processing of your requests.