Get Amerigroup Txpec-1545-15 2016-2025
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How to fill out the Amerigroup TXPEC-1545-15 online
The Amerigroup TXPEC-1545-15 form is essential for submitting precertification requests to ensure timely processing of healthcare services. This guide provides step-by-step instructions on how to accurately fill out the form online, ensuring all necessary information is included to avoid delays.
Follow the steps to successfully complete the form online.
- Click ‘Get Form’ button to access the document and open it in the editor.
- Enter today’s date in the specified field to indicate when the form is being completed.
- Provide the provider return fax number where you would like the responses to be sent.
- Fill in the member information, including first name, last name, and Amerigroup member ID, along with the address, city, state, ZIP code, date of birth, and contact phone.
- Complete any additional member information as required to give more context about the member.
- For the referring provider section, indicate if they are participating or non-participating, then fill in their full name, National Provider Identifier (NPI), provider ID, tax ID number (TIN), office contact name, office phone, office fax, address, city, state, ZIP code, and specialty.
- In the servicing provider section, ensure you fill the required details in a similar manner as the referring provider, designating whether they are participating or non-participating.
- Must provide the servicing facility information, including whether it is participating or non-participating and complete all fields such as NPI, provider ID, TIN, facility contact name, facility phone, facility fax, address, city, state, and ZIP code.
- For the requested service section, check all applicable types of services and fill in the date or date range of the service.
- Enter the corresponding ICD-10 and CPT codes along with the requested units for the service.
- Select the type of service required (e.g., outpatient, planned inpatient, etc.) and place of service (e.g., hospital, office, etc.).
- Lastly, provide any additional information as necessary, submit all appropriate clinical information and documentation to support your request, and include an authorization number if it pertains to an extension or modification of an existing authorization.
- Once all fields are accurately filled, you can choose to save changes, download, print, or share the completed form.
Complete your precertification requests online for a seamless and efficient submission process.
Medicaid is considered a public insurance program, not commercial or private insurance. It serves low-income individuals and families and is funded by the government. Amerigroup TXPEC-1545-15 operates under this public program, providing essential health coverage to eligible Texans. It represents an important resource for those who qualify, ensuring they receive necessary medical support.
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