Get Fl Clear Spring Health Pre-service Authorization Form 2020-2025

Filling out the FL Clear Spring Health Pre-Service Authorization Form is a crucial step in ensuring that necessary services are covered by your health plan. This guide provides a clear, step-by-step approach to completing the form online, tailored to assist users at all experience levels.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the request date in the designated field.
3. Fill in your personal information under the 'Submitted By' section, including your name, phone number, and fax number if applicable.
4. Indicate whether your request is urgent by checking the appropriate box, and ensure that you explain the urgency clearly.
5. Complete the member information section by providing the member's name, plan member ID, date of birth, and phone number.
6. In the requesting provider information section, enter the provider's name, address, and phone number.
7. Provide servicing provider information, including the name, address, phone number, and NPI number if applicable.
8. Specify the location or facility of specialty service by filling out the place of treatment, and check the appropriate boxes for facility type.
9. Under the service request section, select the services being requested, including details such as date of service and relevant ICD 10 or CPT/HCPCS codes.
10. If applicable, include any other relevant information in the designated field.
11. Once all fields are completed, review the form for accuracy and completeness.
12. Save your changes, then download or print the form for submission as needed.

Complete your FL Clear Spring Health Pre-Service Authorization Form online today for timely processing.