Get Az 390-1244 2000-2026

Filling out the AZ 390-1244 form is an essential step in the referral process for medical services. This guide will provide you with clear and structured instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete your AZ 390-1244 form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In Part A, ensure you verify the member's enrollment and note that necessary prior authorization is obtained if required. Complete the pertinent fields to confirm enrollment.
3. In Part B, enter the prior authorization number in the designated space. If you do not have the number, contact the necessary department to verify or acquire it.
4. In Part C, fill out the member's name, member ID, date of birth, sex, and any other insurance information if applicable. Complete the referring physician's details and the information of the consulting physician or provider.
5. Clearly outline the problem or reason for referral in the designated field and provide any necessary clinical information including current CPT-4/HCPCS codes.
6. Indicate whether the referral is for an urgent issue and specify the number of office visits or any other services required.
7. In Part D, the consulting physician or provider should complete their findings and treatment plan, ensuring they include relevant codes and use the appropriate documentation.
8. Complete Part E by checking the necessary boxes and confirming member enrollment. Utilize the telephone numbers provided for any additional inquiries.
9. Once you have filled out all sections accurately, save the changes made to the form. You can then download, print, or share the completed document as needed.

Start filling out your AZ 390-1244 form online today to streamline your referral process.