Get Beacon Health Strategies 90 Day Waiver Form

Filling out the Beacon Health Strategies 90 Day Waiver Form online can be a straightforward process when you know the steps. This guide will walk you through each section of the form, ensuring you provide the necessary information accurately.

Follow the steps to complete the waiver form online:

1. Press the ‘Get Form’ button to access the Beacon Health Strategies 90 Day Waiver Form and open it in your preferred online editor.
2. In the Demographic Information section, enter the following details: Provider Name, NPI number, Member Name, Member ID number, Contact Person, and Telephone number. Make sure all information is correct and up-to-date.
3. Navigate to the Reason(s) for Waiver section. Carefully review the valid reasons for submitting a waiver. Check all that apply, ensuring that the reason aligns with your situation. If you select 'Third party coverage,' please remember to attach a copy of the Explanation of Benefits (EOB).
4. After selecting the relevant reasons, confirm your request for a waiver by marking the statement that certifies the claim for services is true and correct.
5. In the signature field, provide the required Provider Signature along with the date to validate your request.
6. Once you have filled out all sections accurately, review your entries for any mistakes. You can then save your changes, download the document for your records, print it for submission, or share it as necessary.

Start completing the Beacon Health Strategies 90 Day Waiver Form online today!