Get Careallies Initial Pre-certification Request Form - 1199seiubenefits

Filling out the CareAllies Initial Pre-Certification Request Form is a crucial step in ensuring timely approval for necessary services. This guide will assist you in navigating each section of the form online, helping you provide all required information accurately.

Follow the steps to complete your pre-certification request form successfully.

1. Click 'Get Form' button to access the form and open it in an editing interface.
2. Begin by entering the employer or fund information in the designated fields. Provide the Employer/Fund Name accurately to ensure proper identification.
3. Next, move on to the member or patient information section. Complete the fields for Date of Birth (DOB), Member/Patient Name, Member ID, Street Address, City, State, Zip Code, and Phone Number.
4. In the servicing health care professional information area, input the Provider Name, Phone Number, Fax Number, Street Address, City, State, and Zip Code.
5. For the facility information, please enter the Facility Name along with its Street Address, City, Phone Number, Fax Number, State, and Zip Code.
6. Fill out the review request detail information section, including ICD-9 Codes, CPT Codes, Level of Care, and Date of Service.
7. If you have clinical information available, ensure to attach it with this form as required.
8. Upon completing the form, review all entered information for accuracy. After ensuring all details are correct, you can save changes, download, print, or share the form.

Complete your CareAllies Initial Pre-Certification Request Form online today for a seamless approval process.