Get Carecentrix Prior Authorization Form

This guide provides you with clear and comprehensive instructions on how to complete the Carecentrix Prior Authorization Form online. By following these step-by-step directions, you can ensure that all necessary information is accurately submitted for approval.

Follow the steps to complete the Carecentrix Prior Authorization Form effortlessly.

1. Press the ‘Get Form’ button to obtain the Carecentrix Prior Authorization Form and open it in your preferred document editor.
2. Begin by entering the patient's identification information, including their Patient ID number, first name, last name, address, city, state, and ZIP code.
3. Fill in the patient’s height, weight, and Body Mass Index (BMI) in the corresponding fields.
4. Provide the details of the ordering physician, including their name, National Provider Identifier (NPI), address, phone number, and fax number.
5. Indicate the study requested by selecting the appropriate codes for the sleep study options available. Make sure to review the definitions if needed.
6. Discuss whether the home sleep study can be substituted if the facility-based diagnostic test is requested, and provide any required clinical evidence if applicable.
7. Complete Section II by listing the preferred sleep test providers or sleep labs, indicating their names, NPI numbers, Tax ID numbers, addresses, and contact details.
8. In Section III, check all applicable symptoms, comorbid conditions, and any current medications. Provide detailed responses where necessary, especially during repeat studies.
9. Complete the Epworth Sleepiness Score section by entering the likelihood of dozing off in various situations and calculating the total score.
10. Once all sections are filled in accurately, review all entries for completeness and correctness. After verification, you can save your changes, download, print, or share the form as needed.

Start completing your documents online today to ensure a seamless prior authorization process.