Get Mpi Pre-authorization Request
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How to fill out the MPI Pre-Authorization Request online
Filling out the MPI Pre-Authorization Request online is a straightforward process that helps ensure necessary medical services are approved in a timely manner. This guide provides step-by-step instructions to assist users in completing the form accurately and effectively.
Follow the steps to successfully complete your MPI Pre-Authorization Request
- Press the ‘Get Form’ button to access the MPI Pre-Authorization Request form and open it in the editor.
- Complete the provider data section. Enter the treating physician or provider's name, their national provider ID number, today’s date, tax ID number, and the number of pages. Ensure to include the contact person's name, address, location code, city, state, email address, phone number, and zip code.
- Fill in the authorization data section. Provide the patient’s name, date of birth, participant’s ID number, participant’s name, the number of units (visits/services) being requested, and the anatomic site if specific to the service.
- Indicate the date the service is to be performed. Include the diagnosis and relevant ICD-10 codes, as well as the requested procedure and corresponding CPT/HCPCS codes.
- Attach any additional information that may assist with the review. This may include a letter of medical necessity, clinical quality photos, a prescription from the treating physician, consultant reports, office notes, an MPI questionnaire for specific services, and any additional information required by the Motion Picture Industry Health Plan.
- Review the completed form for accuracy. Ensure all necessary sections are filled out completely and clearly.
- Once you have verified the information, save your changes. You may download, print, or share the completed form as needed.
Start filling out your MPI Pre-Authorization Request online today for a smooth review process.
To submit prior authorization for Cigna, collect all relevant medical documentation and complete the required forms specified by Cigna. Ensure that your healthcare provider submits the necessary information on your behalf, following their guidelines for submission. The MPI Pre-Authorization Request offered by US Legal Forms can aid you in preparing the required documents quickly and accurately, making the submission process smoother.
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