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  • Keystone First Kf_1750437 Prior Authorization Form

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Uest Home care Date of service: Requested service: Treating physician name: Physician NPI number: Pending authorization number (if applicable): Dx code(s): CPT code(s) and quantity: HCPC code(s) and quantity: Referring physician name: NPI number: Phone number: Fax number: www.keystonefirstpa.com 100KF-17532.

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Keystone First was founded by the Sisters of Mercy in 1982 as the Mercy Health Plan. The company is a subsidiary of Independence Blue Cross and Blue Cross Blue Shield of Michigan.

Fill Out Paperwork You will probably be asked to fill out some forms that your provider's office will use to submit the request. A prior authorization form will include information about you, as well as your medical conditions and needs.

Federal audit criticizes Keystone First, part of IBC, for denying skilled nursing for children.

The following information is generally required for all prior authorization letters. The demographic information of the patient (name, date of birth, insurance ID number and more) Provider information (both referring and servicing provider) ... Requested service/procedure along with specific CPT/HCPCS codes.

Keystone First is Pennsylvania's largest Medical Assistance (Medicaid) managed care health plan serving more than 400,000 Medical Assistance recipients in Southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery and Philadelphia counties.

Who is responsible for obtaining prior authorization? The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider.

Keystone First has a Medicare plan called Keystone First VIP Choice. You can find out more about our Medicare plan at the Keystone First VIP Choice website Opens a new window.

History. Keystone First was founded by the Sisters of Mercy in 1982 as the Mercy Health Plan. The company is a subsidiary of Independence Blue Cross and Blue Cross Blue Shield of Michigan.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232