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Get Scan Prior Authorization Request Form
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How to fill out the SCAN Prior Authorization Request Form online
Filling out the SCAN Prior Authorization Request Form online can streamline the process of obtaining necessary approvals for medical services. This guide provides clear and detailed instructions for each section of the form to ensure a smooth completion.
Follow the steps to complete the form accurately and efficiently.
- Click ‘Get Form’ button to access the SCAN Prior Authorization Request Form and open it in your preferred editor.
- Enter the date of request in the designated field. Choose an appropriate urgency level: Standard/Routine (up to 14 calendar days), Urgent (not to exceed 14 calendar days), or Expedited/STAT (up to 3 business days) based on the situation.
- Fill out the member information section. Include the member's full name, address, phone number, city, state, zip code, patient ID number, Medicare status (check 'Yes' or 'No'), date of birth, and age. Also, note any other insurance information if applicable.
- Complete the requesting physician information section by providing the requesting physician's name, the name of the person completing the form, and their phone number. Additionally, specify the fax number for returning the authorization.
- In the diagnosis section, write the diagnosis, enter the ICD-9 code, CPT codes, and HCPC codes as needed.
- Fill in the authorization request section, specifying what the request refers to, the frequency of services, the duration, the phone number for contact, and the facility or hospital name and address. Choose whether it's for office, inpatient, outpatient, or 23-hour short stay/observation services.
- Provide a detailed description of the symptoms, including duration, any treatments that have been tried or failed, and relevant lab or diagnostic tests. If possible, fax in supporting documentation with your request.
- Review all entered information for accuracy and completeness. Once confirmed, users can save changes, download, print, or share the completed form as needed.
Complete the SCAN Prior Authorization Request Form online today for efficient processing of your medical service requests.
To obtain a prior authorization form, you can visit the SCAN Health Plan's official website or contact their customer service. Additionally, healthcare providers often have access to the SCAN Prior Authorization Request Form, which they can fill out on your behalf. Make sure to provide your insurance details to ensure a smooth process.
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