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Get Dhs 1144 Instructions 2014-2025
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How to fill out the DHS 1144 Instructions online
The DHS 1144 Form is essential for obtaining medical authorization for specific services and equipment. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.
Follow the steps to complete the DHS 1144 Instructions online.
- Press the ‘Get Form’ button to access the DHS 1144 Form and open it in the online editor.
- In the 'Prior Authorization (PA) No.' field, leave this section blank. An authorization number will be assigned after submission.
- Use the five available lines to describe and code the requested services or items. If more lines are needed, indicate the page numbers and total sheets provided.
- If there is an urgent need for the service or item, check the 'Urgent' box. Do not check 'Urgent' for late submissions or quick approval requests. Select 'Extension Request' for continuing services or 'New Request' if this is the first authorization request.
- Choose only one of the twelve blocks that apply to the type of service being requested; each request requires a separate DHS 1144 form.
- In the 'Recipient Information' section, complete it as the provider. Enter the Medicaid I.D. number, patient's name, gender, and date of birth. Indicate Medicare coverage status with 'Yes' or 'No' and provide the patient's address.
- The physician must fill out their section by describing the requested service, indicating its CPT/HCPCS code, and providing a justification for the medical need. Sign and date the form, certifying the services as medically necessary.
- The supplier section should indicate the purchase price and note whether the item is for rent or repair. Enter relevant serial numbers for specific items if applicable, and ensure authorized signature and contact details are provided.
- After completing all sections, make sure to review the entire form for completeness. Save your changes, and you may download, print, or share the form as needed.
Complete your DHS 1144 Instructions online today for efficient processing of your medical authorization requests.
To fill out an authorization for release of information, start with the individual's name and relevant details about the information being released. Clearly state who is authorized to release the information and to whom it is being sent. It’s helpful to review the DHS 1144 Instructions for any specific considerations related to your needs.
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