Get Care Advocates Precertification Form

Filling out the Care Advocates Precertification Form online can seem daunting, but with a clear understanding of each section and field, you can complete it with confidence. This guide will walk you through the process step by step, ensuring you understand what information is needed to support your request.

Follow the steps to complete the Care Advocates Precertification Form online.

1. Press the ‘Get Form’ button to access the form, allowing you to open it for editing.
2. Fill out the Member Information section. Provide the member's name, birth date, insurance ID number, and phone number. This information is essential for identifying the individual who needs precertification.
3. Indicate the urgency of the request. Choose between elective for routine, non-urgent services, or expedited/urgent if the situation poses a serious threat to the health or well-being of the member.
4. Describe the clinical necessity for an urgent/expedited request in the designated field. This information will help establish the immediate need for the requested service.
5. Complete the Requesting/Ordering Provider section. Enter the provider's name, street address, city, state, zip code, return fax number, and telephone number. Make sure all information is correct to avoid delays.
6. In the Place of Service section, provide the proposed facility's name, NPI, street address, city, state, zip code, and tax ID. Confirm whether the facility is a hospital or associated with one.
7. If applicable, answer the questions regarding medical necessity for the procedure to be performed in a hospital, providing necessary documentation if 'Yes' is selected.
8. For inpatient services, fill in the anticipated admission date, OP to IP status, and type of request. Provide additional details, including the type of service needed and corresponding codes.
9. If submitting a request for outpatient services, fill out the anticipated date of service and select the type of request. Include any additional required information regarding surgical procedures and devices.
10. Before submitting the form, review all fields for accuracy. Ensure that all necessary clinical documentation is attached, as incomplete submissions will delay the processing.
11. Once all information is accurate and complete, save your changes. You may download, print, or share the completed form as needed.

Take the next step towards precertification by completing the Care Advocates Precertification Form online today.