Est is urgent and medically necessary to treat an injury, illness or condition (not life threatening) within 48 hours to avoid complications and unnecessary suffering or severe pain. Urgent requests must be signed by the requesting physician to receive priority. X * INDICATES Required Field Date of Birth MEMBER INFORMATION Member ID/Medicaid ID * Requesting NPI * Requesting TIN * Requesting Provider Contact Name Requesting Provider Name Phone SERVICING PROVIDER / FACILITY INFORMATI.
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How to fill out the MS-PAF-0346 online
Filling out the MS-PAF-0346 form accurately is crucial for obtaining prior authorization for outpatient services. This guide will walk you through each section of the form to ensure you provide the necessary information clearly and effectively.
Follow the steps to successfully complete the MS-PAF-0346 form online.
- Click ‘Get Form’ button to obtain the MS-PAF-0346 form and open it in your editing tool.
- Enter the date of birth of the member in the designated field using the format MMDDYYYY.
- Fill in the Member ID or Medicaid ID in the required field marked with an asterisk (*).
- Provide the Requesting NPI and TIN in their respective fields, ensuring both are marked required.
- Input the name of the requesting provider along with their contact information, including a phone number.
- For servicing provider or facility information, enter the Servicing NPI and TIN, as well as the name and contact details.
- Indicate the primary procedure code along with any modifiers in the required fields, and provide any additional procedure codes if necessary.
- Specify the start date or admission date and end date or discharge date in MMDDYYYY format.
- Fill in the total units, visits, or days of service needed.
- Provide the diagnosis code in the required field.
- Respond to the questions regarding therapy services for school-aged members with disabilities/special needs, marking 'Yes' or 'No' as needed.
- Select the outpatient service type by filling in the relevant square with an 'X'.
- Ensure all required fields are completed. Check for missing clinical information that may delay the processing of your request.
- Once all fields are accurately filled, you may save changes, download, print, or share the completed form as needed.
Complete the MS-PAF-0346 form online today to ensure a smooth authorization process.
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