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  • Ms-paf-0346

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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.

  1. Click ‘Get Form’ button to obtain the MS-PAF-0346 form and open it in your editing tool.
  2. Enter the date of birth of the member in the designated field using the format MMDDYYYY.
  3. Fill in the Member ID or Medicaid ID in the required field marked with an asterisk (*).
  4. Provide the Requesting NPI and TIN in their respective fields, ensuring both are marked required.
  5. Input the name of the requesting provider along with their contact information, including a phone number.
  6. For servicing provider or facility information, enter the Servicing NPI and TIN, as well as the name and contact details.
  7. Indicate the primary procedure code along with any modifiers in the required fields, and provide any additional procedure codes if necessary.
  8. Specify the start date or admission date and end date or discharge date in MMDDYYYY format.
  9. Fill in the total units, visits, or days of service needed.
  10. Provide the diagnosis code in the required field.
  11. Respond to the questions regarding therapy services for school-aged members with disabilities/special needs, marking 'Yes' or 'No' as needed.
  12. Select the outpatient service type by filling in the relevant square with an 'X'.
  13. Ensure all required fields are completed. Check for missing clinical information that may delay the processing of your request.
  14. 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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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232