Get Benefit Investigation Request Form

This guide provides a clear and comprehensive set of instructions on how to complete the Benefit Investigation Request Form online. Filling out this form correctly is essential for ensuring that patients receive the necessary reimbursement support for their healthcare needs.

Follow the steps to successfully complete the Benefit Investigation Request Form online

1. Click ‘Get Form’ button to obtain the Benefit Investigation Request Form and access it for completion.
2. Begin by entering the practice information, including the physician's name, tax ID number, state license number, and other relevant identifiers. Make sure to fill in all required fields accurately.
3. Provide the patient information, including their name, date of birth, and contact details. Select the appropriate product and diagnosis codes from the options available on the form.
4. Fill in the patient insurance details, including the primary and secondary insurance names, policy numbers, group numbers, and contact information for the insurers. If the policyholder is different from the patient, include their information as well.
5. In the authorizations section, check the appropriate box certifying the medical necessity of the selected product (Kyleena, , or Skyla) and authorize Lash Group to act on behalf of the healthcare provider.
6. Once you have completed filling out the form, review all entries for accuracy to avoid any delays in processing.
7. After confirmation that all information is correct, you can save the changes made on the form. The completed form can then be downloaded, printed, or shared as needed.

Take the next step and fill out your Benefit Investigation Request Form online today.