Get Hta Prior Authorization Request Form 01232018

Filling out the HTA Prior Authorization Request Form 01232018 online can seem daunting at first, but with this guide, you will navigate the process with ease. This comprehensive step-by-step instruction set will help you understand each section of the form and ensure all necessary information is accurately submitted.

Follow the steps to complete the authorization request form efficiently.

1. Click the ‘Get Form’ button to access the HTA Prior Authorization Request Form 01232018 and open it for editing.
2. Select the option that corresponds to who is submitting the form, either 'PCP Office' or 'Specialist Office.'
3. Provide the contact information for the person handling this submission, including their phone number.
4. Enter the patient's name and the requesting provider's name, ensuring correct spelling.
5. Indicate the location where the service will be provided by selecting 'Outpatient,' 'Inpatient,' or 'Ambulatory Surgery Center.'
6. Fill in the patient's date of birth, today's date, and member ID, ensuring all details are accurate.
7. Provide the servicing provider's name and NPI, filling in the address and fax number as necessary.
8. Complete the medical coding sections with the appropriate ICD-10 code, CPT code, and indicate the units/quantity for the requested service.
9. Remember to attach any clinical documents that support the medical necessity of the request.
10. Review the form for completeness and accuracy. After confirming all information is correct, you can save changes, download, print, or share the form as required.

Complete your HTA Prior Authorization Request Form 01232018 online today for a straightforward application process.