Get Utilization Management Fax 1-866-685-2759

Filling out the Utilization Management Fax 1-866-685-2759 form is a crucial step in ensuring that your request for authorization is considered. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately with the necessary information.

Follow the steps to successfully complete the form.

1. Press 'Get Form' button to access the form and open it for editing.
2. Enter the patient and member information completely. Include the patient’s name, member name, date of birth, and member ID number in the appropriate fields.
3. Check all applicable conditions in the designated section to describe the patient's condition, selecting from aphakia, keratoconus, anisometropia, high ametropia, or other.
4. Fill in the contact lens brand and design in the specified field.
5. Complete the contact lens prescription section by providing the sphere, cylinder, axis, base curve for both the right (R) and left (L) lenses.
6. Enter the provider's usual and customary fees. Include the contact lens fitting fee and material fee in the required fields.
7. Fill in the provider information, including the requesting physician's name, office contact name, location address, phone number, and fax number.
8. Review all information entered to ensure accuracy and completeness. Ensure that clinical medical records are attached, as narratives will not be accepted.
9. Once all fields are filled out correctly, you can save changes, download the form for your records, print it, or share it as needed.

Complete your authorization requests online today for a smoother process.