Get Prior Authorization Facsimile Request Form Genetic Testing For Brca Mutations For

Navigating the Prior Authorization Facsimile Request Form for genetic testing can be straightforward with the right guidance. This document serves as a step-by-step resource for users, ensuring that all necessary information is accurately completed to facilitate a smooth approval process.

Follow the steps to effectively complete the form

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Begin by filling out the top section with the date, ordering physician's name, and their TIN number. Also provide the complete address, including city, state, and ZIP code.
3. Next, enter the member's name and their member ID number in the provided fields.
4. Proceed to Part A, if required, and ensure the Genetic Counseling Attestation Form is completed by an independent genetics care provider. This includes filling in the provider's information such as name, tax ID number, NPI, address, and contact details.
5. Check the appropriate recommendation box to indicate whether the member meets the medical policy criteria for testing or not, and provide any relevant personal or family history details as required.
6. Organize and attach all required clinical documentation that supports the request. This includes clinical notes, three-generation pedigree, personal history of cancer, and ethnicity details.
7. Fill in Part B, providing the laboratory name, address, TIN, and test name, along with the date of service for sample collection.
8. Select the requested CPT codes for prior authorization and indicate which medical policy criteria the member meets by checking the appropriate boxes and providing requested details.
9. Finally, review all filled fields for accuracy and completeness, then save changes to your form. You can then download, print, or share the completed document as necessary.

Complete your Prior Authorization Facsimile Request Form online today to facilitate timely testing.