Get Mmai Preauthorization Form - Blue Cross And Blue Shield Of Illinois

Filling out the MMAI Preauthorization Form accurately is essential for ensuring prompt processing of requests. This guide provides clear and supportive instructions on how to efficiently complete the form online.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering today's date in the designated field at the top of the form. Ensure you follow the format MM/DD/YYYY for clarity.
3. Next, complete the scheduling section by indicating the anticipated service date. This date is also formatted as MM/DD/YYYY.
4. Fill in the provider data section, starting with the submitting provider's information. Enter the provider's contact first name, last name, and telephone number.
5. Proceed to the ordering physician's section. Enter the ordering physician's first and last names and their contact information. Include their telephone and fax numbers.
6. Check the rendering provider/facility section. Provide the name of the rendering facility or physician, their contact information, and their street address, city, state, and zip code.
7. Move to the member data section. Input the member identification number, group number, and personal details of the member, which include their first and last names and date of birth.
8. Complete the documentation section. Attach relevant documentation that supports the request. Indicate the place of treatment and check any applicable items, including evaluation/health history and procedure codes.
9. Once all sections are complete, review the form for accuracy and completeness. Make sure all required fields are filled out to avoid delays in processing.
10. Finally, save the completed form. You can download it, print it, or share as needed.

Complete your MMAI Preauthorization Form online today to ensure timely processing of your requests.