Get Provider Referral Bform Requestb For Pre Bb

Filling out the provider referral form request for pre-authorization online is a crucial step in ensuring that the necessary services are authorized. This guide provides clear and detailed instructions for completing the form accurately and efficiently.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Begin by filling in the member’s first and last names, along with the member's plan, date of request, date of birth (DOB), and member ID. Ensure that all fields are accurately completed to avoid processing delays.
3. Provide ordering provider information, including their name, address, phone number, office contact name, specialty, city, fax number, and zip code.
4. Detail the information for the member being referred by filling in their name, address, phone number, office contact name, specialty, city, billing NPI (required), fax number, zip code, and TIN.
5. Check the box for the requested service type and fill in any additional relevant details such as physician name, performing surgeon name, ICD-10 codes, number of visits, and necessary notes.
6. Complete the sections for additional services like home health care, hospice, mental health outpatient services, or injectable/IV therapy, providing all respective details.
7. Review all completed fields to ensure accuracy. Once you are satisfied with your entries, proceed to save your changes, download a copy, print it, or share the completed form as needed.

Complete your provider referral form request for pre-authorization online today to ensure timely processing of your services.