Get Prior Authorization Fax Request Form - Who's In The Advantus ...

The Prior Authorization Fax Request Form - Who's In The AdvantUs is a critical document for initiating the prior authorization process for healthcare services. This guide provides clear, step-by-step instructions on filling out the form to ensure all necessary information is submitted accurately and efficiently.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the form and open it in your document editor.
2. Begin by entering the date at the top of the form.
3. Complete the member information section. Enter the member's first name, middle initial, last name, date of birth, phone number, and member ID.
4. Fill out the requesting physician section by entering the physician's name, specialty, contact phone number, address, city, state, zip code, NPI number, contact person, and their phone and fax numbers.
5. In the facility section, provide details about the facility name, contact phone number, address, city, state, and zip code.
6. Indicate the date(s) of service required for the request.
7. Provide the necessary clinical information, which should include health history, physical assessment details, test results, consultation reports, prior treatment history, and any relevant OB-delivery information.
8. Enter the diagnosis and corresponding ICD-10 code(s).
9. Specify the procedure or service requested and provide the CPT and HCPCS codes, if applicable.
10. Review all completed sections for accuracy and completeness.
11. Once all fields are filled, save your changes. You can then download, print, or share the form as needed.

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