Get Fl Paf 0699 Instructions To Fillable

This guide provides comprehensive instructions on how to fill out the Fl Paf 0699 form online. It is designed to assist users in accurately completing each section to ensure a smooth submission process.

Follow the steps to complete the Fl Paf 0699 form online.

1. Click the ‘Get Form’ button to obtain the form and access it in the online editor. This button will facilitate your entry into the filling process.
2. Begin by entering the member information. Make sure to fill in the member ID and the date of birth in the specified format (MMDDYYYY). Include the member's last name followed by their first name.
3. Next, you will need to provide the requesting provider information. Fill in the requesting NPI, TIN, contact name, and provider name. Additionally, include the phone and fax numbers for the requesting provider.
4. Fill out the servicing provider or facility information. You can choose to indicate if this is the same as the requesting provider by selecting the appropriate option. If different, add the servicing NPI, TIN, contact name, and provider/facility name, as well as phone and fax numbers.
5. Proceed to the authorization request section. Indicate the primary procedure code, additional procedure codes if applicable, and provide the start or admission date. Make sure to include the total units, visits, or days as required.
6. Indicate the outpatient service type by entering the service type number corresponding to the relevant category. You can include any diagnosis codes needed in this section.
7. Ensure that all required fields marked with an asterisk are completed. An incomplete form will lead to rejection.
8. Upload copies of all supporting clinical information within the form to avoid any delays in decision-making.
9. Once you have filled out all sections, review the form for accuracy. Make any necessary adjustments before finalization.
10. Finally, save your changes. You may choose to download, print, or share the filled form as needed.

Complete your documents online now to ensure timely processing.