Follow the steps to complete your form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the policy holder information section. Enter the name of the policy holder, followed by their Card ID number, address, telephone number, city, state, and pin code. Ensure that all details are accurate to avoid delays.
3. Next, move to the patient information section. Include the patient's name, relationship to the policy holder, Unique Health Identifier (UHID) of the healthcare provider, and contact details including email.
4. In the provider information section, specify the provider's name and their registration number. Include the provider's address, city, state, and pin.
5. Complete the service line information by listing the relevant services used during the hospitalization. Include details such as service description, amounts for room charges, ICU/CCU/nursery charges, doctor's fees, lab investigations, radiology, and any special procedures.
6. Indicate any applicable discounts, calculate the net amount, patient paid amount, and balance due. Include any remarks related to the services provided.
7. Review the list of enclosures and tick the relevant boxes to indicate the documents being submitted with the form, such as discharge summaries and investigation reports.
8. Lastly, sign and date the form acknowledging the truth of the information provided and the agreement to the terms stated.
9. Once you have filled in all required sections, save your changes. You may then download, print, or share the form for your records.

Start filling out your East West Preauth Form online to ensure your hospitalization claims are processed efficiently.