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Get Carefirst Bcbs Cut0124-1e 2016
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How to fill out the CareFirst BCBS CUT0124-1E online
Filling out the CareFirst BCBS CUT0124-1E form online is a straightforward process that allows users to request authorization for outpatient pre-treatment services. This guide provides step-by-step instructions to ensure a smooth completion of the form.
Follow the steps to complete your CareFirst BCBS CUT0124-1E form effectively.
- Press the ‘Get Form’ button to access the CareFirst BCBS CUT0124-1E form and open it in your preferred online editor.
- Begin by checking all applicable services under the Outpatient Pre-Treatment Authorization Program (OPAP) section, including physical therapy, occupational therapy, acupuncture, and more.
- Fill in the case information, including the patient's name, date of birth, subscriber member ID number, and gender, ensuring that the information is accurate.
- Enter the number of visits required and the date of service range, indicating the start and end dates using the MM/DD/YYYY format.
- Provide the diagnosis codes (ICD-10) for both the primary and secondary conditions, as well as details of the servicing practitioner, including their BlueChoice regional provider ID or tax ID number if they are non-participating.
- Complete the office/facility name and enter the practitioner's address, including city, state, and zip code.
- In the contact information section, fill out the office name, phone number, email address, tax ID number, and office fax number.
- If applicable, provide any previous authorization numbers in the authorization extension section and specify the action requested, such as extending the end date or adding visits.
- Review your form for accuracy and completeness. Once confirmed, you can save the changes, download, print, or share the form as necessary.
- Finally, fax the completed form to 410-505-6404 within five days from the initial evaluation to avoid any potential delays in claims payment.
Complete your CareFirst BCBS CUT0124-1E form online today for a seamless authorization process.
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Yes, CareFirst BCBS CUT0124-1E operates under the Blue Cross Blue Shield umbrella. CareFirst serves as the administrator for Blue Cross Blue Shield plans in specific regions. Therefore, if you are a CareFirst member, you benefit from the broader network and services associated with the Blue Cross Blue Shield brand.
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