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LEAVE THIS AREA BLANK COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES OFFICE OF MEDICAL ASSISTANCE PROGRAMS OUTPATIENT SERVICES AUTHORIZATION REQUEST 1 3 PRIOR AUTHORIZATION PATIENT INFORMATION
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What is outpatient services authorization request?
Outpatient services authorization request is a request for approval from the insurance company or healthcare provider to receive medical services outside of the hospital.
Who is required to file outpatient services authorization request?
The healthcare provider or the patient is required to file the outpatient services authorization request.
How to fill out outpatient services authorization request?
To fill out the outpatient services authorization request, you need to provide information such as patient's personal details, medical diagnosis, treatment plan, and insurance information.
What is the purpose of outpatient services authorization request?
The purpose of outpatient services authorization request is to ensure that the medical services being requested are necessary and covered by the insurance plan.
What information must be reported on outpatient services authorization request?
The information that must be reported on the outpatient services authorization request includes patient's name, date of birth, diagnosis, requested services, healthcare provider's information, and insurance details.
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