Get Ak Triwest Ak Secondary Authorization Request (sar) Form 2017-2025

Successfully completing the AK TriWest AK Secondary Authorization Request (SAR) Form is essential for obtaining necessary healthcare services. This guide offers clear instructions tailored to users, ensuring a smooth online filing process.

Follow the steps to accurately complete the form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the appropriate editor.
2. Begin with Section I: Patient Information. Fill in the last name, first name, address, date of birth, city, state, and zip code of the patient accurately.
3. Move to Section II: Requesting Provider Information. Provide the requesting provider's name, contact person, TIN, phone number, address, fax number, specialty type, group name, and check if the request is Routine, Urgent, or Emergent.
4. In Section III: Type of Care Request, enter the diagnosis using the ICD 10 Code/Description. Specify the date of service and/or anticipated length of care, and include the CPT/HCPCS code/description of the requested service. Indicate whether there is a referral to another specialty and provide the necessary servicing provider information if applicable.
5. Proceed to Section IV: Type of Services Requested. Check the appropriate boxes for physical therapy (PT), occupational therapy (OT), speech therapy, surgical procedure, additional office visits, emergency room care, labs, radiology/imaging, and pre-operative labs. Fill out any required details and indicate the facility name if needed.
6. In Section V: Clinical Information, attach any necessary documentation such as office notes, treatment plans, clinical history, and any related results to support the medical necessity of the requested services. Indicate if additional information is attached.
7. Complete Section VI: Discharge Needs if requesting inpatient admission/procedure. List any specific needs such as DME, home health, skilled nursing facility, and provide relevant details.
8. To ensure timely processing, attach the most recent office notes and plan of care along with the form. Once finished, save your changes, and consider options to download, print, or share the completed form as needed.

Complete your documents online to ensure a seamless authorization process.