Follow the steps to complete the Netprepar form accurately.

1. Click the ‘Get Form’ button to obtain the Netprepar form and open it in your preferred editor.
2. Fill in the member information section by entering the member ID or Medicaid ID in the designated field, as well as the date of birth. Ensure that you enter the date in the format MMDDYYYY.
3. Complete the requester's information by providing the requesting provider's NPI and TIN. Additionally, fill in the requesting provider's name, contact name, phone, and fax numbers.
4. If the servicing provider is the same as the requesting provider, select the corresponding option. Otherwise, fill in the servicing provider's NPI, TIN, and facility name, along with the contact name, phone, and fax numbers.
5. In the authorization request section, input the relevant ICD-9 or ICD-10 codes for diagnosis, as well as the primary procedure code (CPT/HCPCS) and any additional procedure codes, if applicable.
6. Indicate the inpatient service type by entering the service type number in the provided boxes. Select options that accurately reflect the nature of the service required.
7. Fill out the admission date or start date as well as the discharge date if applicable, ensuring you use the MMDDYYYY format.
8. Review all fields to ensure that every required field marked with an asterisk (*) is filled out. Incomplete forms may result in a rejection of the authorization request.
9. Once you have completed the form, save any changes, and consider downloading or printing a copy for your records before proceeding to share or submit the completed form.

Complete your Netprepar form online today to ensure timely processing of your authorization request.