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Get Cdn.cocodoc.comcocodoc-form-pdfpdfSleep Study Prior Authorization Request Form

Diagnostic prior authorization requests. The most recent clinical notes and current medication list (medications the member has been prescribed for the last 30 days) must also accompany the faxed request. We recommend that all requests for sleep related services are submitted via our provider portal at: www.sleepsms.com or www.carecentrixportal.com. Entire completed form Current Medication list Updated clinical notes Insurance Plan: Patient Subscriber ID#: Diagnosis Code: Patient First Na.

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