Get Icare Prior Authorization Form

Completing the Icare Prior Authorization Form online is a crucial step in ensuring that the necessary medical services are authorized efficiently. This guide will provide you with step-by-step instructions to navigate each section of the form with ease.

Follow the steps to complete the Icare Prior Authorization Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Enter today's date in the designated field, ensuring it reflects the current date you are submitting the request.
3. Fill in the member information section, including the member's name, date of birth (DOB), plan name, and member ID. Be sure to double-check for accuracy.
4. Provide the requesting provider information by entering the provider ID, provider name, location of service ID, service address, service name, phone number, fax number, and contact person.
5. Specify the requested procedures by entering the diagnosis code(s), CPT code(s), laterality (RT/LT), and date of service (DOS). Add any additional comments in the comments section.
6. Review the prior authorization requirements for specific codes by referring to the 'Prior Authorized CPT Codes' listed in the provider manual or through the online resource.
7. Confirm that you have included complete clinical medical records, as narratives are not accepted in lieu of these. Ensure all documentation is ready for submission.
8. After reviewing all fields for completeness and accuracy, save your changes, and choose to download, print, or share the form as needed.

Complete your documents online to ensure timely processing and authorization.