Get Fhcp Precertification Form - Florida Health Care Plans

Filling out the FHCP precertification form is an essential step in ensuring timely healthcare services. This guide provides clear, step-by-step instructions to help users navigate the online form with ease.

Follow the steps to complete the FHCP precertification form online.

1. Press the ‘Get Form’ button to access the FHCP precertification form and open it in your preferred online editor.
2. In the form, start by entering your Tax ID number and the date of the request in the designated fields.
3. For the type of referral, select whether you need a routine or urgent referral by marking the appropriate option.
4. Provide the requesting provider’s name in the clearly marked section.
5. Fill in the contact or caller's name, phone number, and extension if applicable.
6. Enter the patient’s name, date of birth, and FHCP medical record number in the correct fields.
7. Specify the surgical procedure, including relevant CPT and ICD-9 codes, along with the anticipated surgical procedure date.
8. Indicate the surgeon’s name and the facility’s name providing the service.
9. Select whether the procedure is inpatient or outpatient, and if applicable, include the planned pre-op testing date.
10. In the next section, provide details about office visits or tests requested by naming the provider or type of test.
11. If relevant, indicate if the test is with or without contrast, and specify the appointment date.
12. Complete the section for the testing facility name and provide the corresponding diagnosis code.
13. Finally, review the internal use section and ensure that it is filled out if required before submitting.
14. Once all fields are completed, save your changes, and you may download, print, or share the form as necessary.

Complete your FHCP precertification form online for a smooth healthcare service experience.