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Get Or Regence Bcbs Form 5266or 2014
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How to use or fill out the OR Regence BCBS Form 5266OR online
Filling out the OR Regence BCBS Form 5266OR online is a straightforward process that assists healthcare providers in obtaining pre-authorization for necessary services. This guide will walk you through each section of the form, ensuring that you understand how to complete it accurately and efficiently.
Follow the steps to complete the OR Regence BCBS Form 5266OR online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by providing patient information in Section 1. Fill in the patient's last name, first name, Regence member ID number, and group number. Ensure that all fields are completed accurately.
- Proceed to Section 2, which focuses on provider information. Indicate whether you are the requesting provider or the rendering provider. Enter the patient's phone number, date of birth, and, if applicable, the DME supplier's tax ID number. Include your name, phone number, NPI, and address.
- In Section 3, identify the type of pre-authorization request you are making. Choose whether it is a pre-service or concurrent review and provide the date of service. Select the appropriate setting for the service (outpatient hospital, inpatient, ASC, office, or other) and detail the request type (surgical, DME, diagnostic, medical, or other).
- Complete the anticipated admission details for inpatient services or DME. If applicable, provide the anticipated length of stay and relevant tax ID and NPI numbers.
- Indicate whether a signed copy of the prescription or an invoice is attached. For expedited requests, mark the appropriate box and ensure your fax number is included.
- List all relevant diagnosis codes, CPT®, or HCPCS codes along with their descriptions. Provide the line item cost for DME as necessary.
- Submit any clinical information required for the request, such as history & physical, lab results, treatment history, or any additional documentation that supports medical necessity.
- Once all information is filled out and verified, you can save changes, download, print, or share the completed form as needed.
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The payer ID for BCBS of Oregon is integral for processing claims. You will often find this ID listed in your member documentation or on their website. To ensure smooth claim submissions, consider using OR Regence BCBS Form 5266OR for all your related paperwork.
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