Get Unmc Preauthorization Information Form 2020

The UNMC Preauthorization Information Form is an essential document for requesting insurance authorization prior to specimen collection. This guide will provide you with clear and step-by-step instructions on how to accurately fill out the form online, ensuring that you provide all necessary information.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the UNMC Preauthorization Information Form and open it in your preferred online editor.
2. Begin by filling out the patient information section. Include the patient's name, date of birth, medical record number, address, and biological sex. Ensure that this information is correct and clearly written.
3. Indicate the reason for testing or provide the relevant ICD codes in the section labeled 'Indications for Testing or ICD.' This helps insurance carriers understand the need for the requested tests.
4. Upload a legible copy of the patient's insurance card in the insurance information section. Clearly enlarge and include both the front and back of the card as required by the authorization process.
5. Fill out the policy holder's information if it differs from the patient's. Provide the policy holder's name and date of birth.
6. Select the tests to be authorized under the 'Testing to Be Authorized' section. Review the list carefully and mark the appropriate tests that are relevant to the patient.
7. In the clinical information section, indicate if you are attaching clinical records, such as family history, pedigree, or previous genetic testing reports. Check the appropriate box to confirm records are included.
8. Provide the provider's information, ensuring that you include their name, facility, and contact information. This is crucial for any communication related to the authorization.
9. Choose your preferred method of receiving the authorization determination by selecting either email or fax, and provide the necessary contact details.
10. Once all sections are completed, submit the form by emailing it to the billing support team at rpsbillingsupport@unmc.edu or faxing it to 402-559-8359.

Take the next step in the authorization process by completing your forms online today.