Get Allergist 1199seiu

Filling out the Allergist 1199seiu form online can streamline the authorization process for allergy-related services. This guide offers a step-by-step approach to ensure that all necessary information is accurately captured.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the request submitted by information, including the request date. Make sure to use the format MM/DD/YYYY.
3. In the '1199SEIU MEMBER INFORMATION' section, provide the member's last name, first name, and member ID accurately.
4. If the patient is not the member, fill in the patient information by providing their last name, first name, and date of birth in the format MM/DD/YYYY.
5. List the CPT/HCPCS codes and descriptions relevant to the service requested. Ensure that you include any principal and secondary ICD 10 codes along with their descriptions.
6. Describe the complaints pertinent to the request, provide pertinent history, and detail the objective findings observed.
7. Document any prior treatment or medication therapy, including outcomes and the results of any prior diagnostic studies.
8. Indicate whether you have a copy of the desensitization records from initial to current by selecting 'Yes' or 'No.'
9. Outline the proposed treatment plan clearly to ensure all necessary information is available for review.
10. Proceed to the 'PHYSICIAN INFORMATION' section by entering the physician's name, date, specialty, telephone, fax, TIN, and address components.
11. Fill in the 'FACILITY/VENDOR INFORMATION' section with the facility/vendor's name, TIN, contact information, and address to ensure proper service provision.
12. Capture the authorized signature of the vendor and the signature of the contact person along with their titles.
13. Review all the filled fields for completeness and accuracy to prevent any issues with the authorization request.
14. Once completed, save changes to the form. You may also opt to download, print, or share the form as necessary.

Complete the Allergist 1199seiu form online today to ensure timely service authorization.