Get Metroplus Health Plan Authorization Request Form 2020-2025

Completing the MetroPlus Health Plan Authorization Request Form online is a straightforward process that helps ensure you receive the necessary authorizations for your health plan services. This guide provides step-by-step instructions to assist you in accurately filling out the form.

Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the 'Member Information' section. Provide the member's name, address, date of birth, and member ID number. Ensure all information is accurate to avoid processing delays.
3. Proceed to the 'Provider Information' section. Enter the servicing provider's name, fax number, ID number or tax ID, phone number, address, and contact name with direct extension if applicable.
4. In the 'Service Information' section, specify the requested dates of service, indicating both the start and end dates. Include the relevant CPT/HCPCS codes as applicable.
5. Select the appropriate admission type for inpatient services by checking the corresponding box, or choose from the outpatient options for additional services. Ensure to describe if the request is for new services, additional services, or extending a current authorization period.
6. Provide comments if necessary to clarify your service request or additional information that may assist in processing.

Complete your MetroPlus Health Plan Authorization Request Form online today to expedite the processing of your health service requests.