Get Provider Fax - Better Health

Filling out the PROVIDER FAX - Better Health form is essential for ensuring that primary care providers can efficiently communicate necessary authorizations. This guide provides clear instructions on completing the form online, making the process straightforward and accessible for all users.

Follow the steps to fill out the PROVIDER FAX - Better Health form correctly.

1. Press the ‘Get Form’ button to access the provider fax form and open it in your editor.
2. In the 'To' section, enter the name 'Providers of Better Health.'
3. Fill in the 'Date' field with the current date.
4. In the 'Re' section, specify 'Revisions to Quick Authorization Form (QAF).'
5. Locate and fill out the 'Member Name,' 'ID#,' and 'DOB' fields accurately.
6. Complete the 'Date' and 'Phone' sections with the relevant information.
7. Enter your primary care provider's name and contact number in the designated fields.
8. Indicate the 'Referred to Specialist Name' and their fax number.
9. Choose details regarding extremities studies as applicable, by checking the appropriate boxes.
10. Input required diagnosis codes in the provided section and ensure to include the provider's signature.
11. Review all filled information for accuracy before saving your changes, and proceed to download, print, or share the completed form.

Complete your documents online to ensure efficient processing and stay organized.