Get 2016-10 Authorization Form - Bcbsla.com

Filling out the 2016-10 Authorization Form is essential for obtaining necessary approvals for medical services under Blue Cross and Blue Shield of Louisiana. This guide provides clear instructions on how to complete the form accurately and efficiently online.

Follow the steps to fill out the Authorization Form online.

1. Press the ‘Get Form’ button to access the form and open it in the editor.
2. Complete the patient data section with the patient's last name, first name, middle initial, date of birth, and member ID. Ensure all information is accurate to avoid processing delays.
3. Fill in the clinical data section. Indicate whether it is an inpatient admit/surgery, outpatient procedure/service, or office visit. Provide the diagnosis codes (ICD-10) and CPT® codes as applicable.
4. If applicable, include the number of visits requested and the date of service or admit date in the designated fields.
5. Complete the requesting physician section with their last name, first name, middle initial, address, phone number, and fax number. Additionally, include the National Provider Identifier (NPI) for the physician.
6. Fill in the facility information section with the facility name, address, and National Provider Identifier (NPI).
7. Provide the contact person's name in the designated section.
8. Review the form thoroughly to ensure all fields are completed accurately. Remember that incomplete forms may delay authorization processing.
9. Once you have filled out the form, save any changes you made. You can then download, print, or share the completed form as needed.

Complete your 2016-10 Authorization Form online today for efficient processing.