Get Chme Prior Authorization Request - Portal Chcnetwork

This guide provides a clear and supportive approach to filling out the CHME Prior Authorization Request. It includes detailed instructions for each section of the form to ensure accuracy and completeness while submitting your request online.

Follow the steps to accurately complete your authorization request.

1. Use the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin by selecting the type of request you are submitting: routine, urgent, modification, or retro. Ensure that you understand the processing times associated with each option.
3. Fill in the 'Requesting Provider' section with required information such as name, address, NPI number, and contact information. Ensure all bolded fields are completed.
4. In the 'Member' section, provide the necessary details about the member, including first name, last name, health plan ID, date of birth, and contact information. If the request is for a newborn, make sure to provide the mother's information as well.
5. Specify the place of service by selecting one of the options: inpatient, outpatient, doctor’s office, ambulatory surgical center, DME, or HHA.
6. In the 'Authorize To' section, enter the name/facility and additional information for the provider who will perform the services, including their NPI number and contact details.
7. Complete the 'Diagnoses / Service Codes' section by entering the relevant ICD-10 codes, CPT/HCPCS codes, modifiers, and quantities for each service being requested.
8. After filling out all sections, review the form for accuracy and ensure all required fields are completed before saving your document.
9. Once finalized, you can save your changes, download the document, print it for your records, or share the form as needed.

Complete your CHME Prior Authorization Request online for a seamless submission process.