Get Thsteps Dental Mandatory Prior Authorization Request Form If Any Portion Of This Form Is Incomplete

Completing the THSteps Dental Mandatory Prior Authorization Request Form accurately is essential to ensure timely approval for dental procedures. This guide will walk you through each section of the form, providing clear instructions to help users complete it online effectively.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin filling in the client’s name, including the last name, first name, and middle initial. Ensure all details are accurate to avoid delays.
3. Enter the Medicaid number in the designated field, ensuring the number matches the client’s records.
4. Provide the client's date of birth in the format specified (MM/DD/YYYY) to ensure clarity.
5. Check the appropriate boxes for the restorative services being requested, including options like Panorex, FM X-ray, and orthodontic services. Ensure that all selected documentation is ready for review.
6. Indicate the date diagnostic tools were produced by entering the date in the specified format.
7. Fill out the proposed treatment plan by including the procedure code, tooth number or letter, surface, and charge for each item.
8. Complete the dentist's certifications by checking each applicable box and providing a signature to affirm the statements made.
9. Input the dentist’s printed or typed name, contact telephone number, physical address, fax number, TPI, NPI, and taxonomy information as required.
10. Once all sections are completed, review the form carefully for any missing information or errors before saving changes, downloading, or printing the form for submission.

Ensure all documentation is complete and submit your request online to facilitate a smooth authorization process.