Get Dmap 3086 Prior Authorization Request - Non-emergent Medical Transportation For Subsidized

The DMAP 3086 Prior Authorization Request form is essential for securing authorization for non-emergent medical transportation for individuals in subsidized adoptions. This guide provides clear, user-friendly instructions on how to complete the form online, ensuring that all required information is accurately submitted.

Follow the steps to complete the DMAP 3086 form effectively.

1. Click ‘Get Form’ button to access the DMAP 3086 form and open it in your preferred editor.
2. In the client information section, fill out all required fields accurately. Provide the child(ren)’s name(s), Medicaid ID(s), mailing address, city, state, and ZIP code. Be sure to only list multiple children if they are attending the same healthcare facility on the same trip.
3. Next, enter the parent or guardian’s name and provide a contact phone number. This information is crucial for any follow-up communication.
4. Move to the appointment information section. For each appointment, provide the date, provider name, appointment time, and provider phone number. Clearly state the reason for the appointment.
5. Indicate whether meals or lodging are needed by selecting 'Yes' or 'No' for each appointment. Remember that meals and lodging are only covered under limited circumstances for the child and one parent or guardian.
6. Complete the DMAP use only section as needed. Leave space for the PA request status to be filled in after submission.
7. Once all fields are completed, review the form for accuracy. Ensure that all required information is filled out before submission.
8. Save any changes and proceed to download, print, or share the completed form as needed.

Complete your DMAP 3086 Prior Authorization Request online now to ensure timely processing.