Get Geha Therapy Fax Request Form

Filling out the Geha Therapy Fax Request Form is a straightforward process that allows providers to request necessary therapy services for their patients. This guide will help you navigate the form's components step by step, ensuring all required information is accurately submitted.

Follow the steps to complete the form effectively:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the fax date and the total number of pages being faxed. This information is crucial for tracking purposes.
3. Fill in the therapy provider information, including the facility name, street address, state, city, telephone number, zip code, and fax number. Additionally, provide the national provider identifier (NPI), GEHA provider ID number, or the relevant facility or individual NPI number.
4. In the 'Request Information' section, indicate the type of request, including options for therapy visits pre-certification or other procedures, along with the associated tax ID numbers where applicable.
5. Next, provide patient information, including whether the request is for post-operative therapy visits, service type, patient's first and last name, date of birth, GEHA member ID number, and diagnosis in ICD-9 format.
6. Indicate the initial evaluation date and the requested number of visits for the therapy services needed.
7. Review all entries for accuracy, ensuring clarity and completeness. Use black ink and print legibly.
8. Finally, save your changes, and make sure to share or print the completed form as needed, along with any supporting clinical data.

Start completing your Geha Therapy Fax Request Form online today!