Get Standardized Prior Authorization Bformb Instructions - Wellsenseorg - Wellsense

Filling out the Standardized Prior Authorization BForm is an important step for service providers seeking authorizations for Medicaid-enrolled beneficiaries. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to access the Standardized Prior Authorization Request form and open it in your preferred document editor.
2. Begin filling out the form by entering the health plan name in the specified section, ensuring accuracy in the name of the authorizing entity.
3. Select the urgency type for your request by checking either the 'Urgent' or 'Standard' box to indicate the required time frame for the decision.
4. Input the health plan fax number, making sure to include the area code.
5. Check all service types requiring authorization. Be thorough and ensure that you check the appropriate boxes related to the services requested.
6. Provide member information, including member ID, date of birth, and full name as it appears on the registration card.
7. Fill out the requesting provider's information, including the NPI and TIN numbers.
8. Complete the servicing provider's information; include NPI, TIN, and contact details.
9. In the authorization request section, detail primary and additional procedure codes as applicable.
10. Indicate start/admission and end/discharge dates, along with diagnosis codes and total units/visits/days as necessary.
11. Utilize the comments section to provide any additional information that may assist in processing the request.
12. Once all sections are completed, make sure to save the changes made to the form. You may download, print, or share the final version as needed.

Complete the Standardized Prior Authorization BForm online to ensure efficient processing of your service requests.