Get For Faster Authorization Home Health Care Re-authorization ...

Completing the FOR FASTER AUTHORIZATION HOME HEALTH CARE Re-AUTHORIZATION form online can streamline the process for securing necessary home health services. This guide provides detailed steps to help you fill out the form accurately and efficiently.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to access the authorization request form and open it in the digital editor.
2. Enter the date of your request in the designated field. Specify whether this is a standard or retroactive request.
3. Provide the member's name and indicate if the request is urgent. Note that urgent requests should only be submitted if the member's health is at serious risk.
4. Fill in the agency name and NPI number, as this information is required for processing.
5. Enter the member's date of birth and your contact information, including name and phone number.
6. Input the member ID number, ensuring it is accurate and complete.
7. Specify whether the request requires review per the portal. If yes, provide the reason.
8. Indicate if there is a caregiver who is able, willing, and teachable by checking the corresponding box.
9. List the authorization number if applicable and explain if it is not provided.
10. Enter the start of care date and provide the name and contact information for the physician or NP overseeing the care.
11. Document the diagnosis by listing the corresponding codes and descriptions in the fields provided for primary, secondary, tertiary, and quaternary diagnoses.
12. Select the type of residence where the member resides from the options given.
13. Outline the agency recommendations/requests, including discipline, number of visits, date range, and frequency.
14. Ensure the required checklist is reviewed by submitting the specified documents alongside the completed form.
15. Finally, save your changes, then download, print, or share the completed form as needed.

Complete and submit your documents online today to ensure timely authorization for home health care services.