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MOLINA HEALTHCARE UTAH MEDICAID PRIOR AUTHORIZATION/PRESERVICE REVIEW GUIDE EFFECTIVE: 01/01/2018 REFER TO MOLINA PROVIDER WEBSITE OR PORTAL FOR SPECIFIC CODES THAT REQUIRE AUTHORIZATION ONLY COVERED

How to fill out 2018 prior authorizationpre-service review

How to fill out 2018 prior authorizationpre-service review:

1. Familiarize yourself with the purpose of the prior authorization pre-service review. Understand that it is a process used by insurance companies to determine if a specific medical treatment or procedure is necessary and will be covered by the insurance plan.
2. Obtain the necessary forms or access the online platform provided by your insurance company for submitting prior authorization requests. Ensure that you have the most recent version of the forms.
3. Gather all relevant medical documentation that supports the need for the requested treatment or procedure. This may include medical records, test results, and a letter of medical necessity from your healthcare provider.
4. Review the instructions provided on the prior authorization form or online platform. Pay close attention to any specific requirements or documentation needed that may be unique to your insurance company.
5. Complete the patient information section of the form accurately and legibly. Include your full name, date of birth, insurance information, and contact details.
6. Provide detailed information about the treatment or procedure being requested. Include the CPT code, a brief description of the service, and the anticipated start date.
7. Attach all necessary supporting documentation as required by your insurance company. This may include medical records, test results, and any additional forms that need to be completed by your healthcare provider.
8. Double-check that all sections of the form are filled out completely and accurately. Ensure that all required fields are filled, and there are no missing or inconsistent information.
9. Make copies of all the completed forms and supporting documentation for your records before submitting them to your insurance company.
10. Follow the submission instructions provided by your insurance company. This may involve mailing the forms or submitting them electronically through their online platform.
11. Keep track of the progress of your prior authorization request. Follow up with your insurance company if you haven't received a response within the specified time frame.
12. Be prepared to provide any additional information or answer any queries that may arise during the prior authorization review process.

Who needs 2018 prior authorization pre-service review:

1. Individuals who have health insurance plans that require prior authorization for certain medical treatments or procedures.
2. Patients who are considering undergoing a medical treatment or procedure that may not be automatically covered by their insurance plan.
3. Healthcare providers who need to initiate the prior authorization process on behalf of their patients to ensure reimbursement for specific services.

Note: The specific requirements for prior authorization pre-service review may vary depending on the insurance company and the type of healthcare service being requested. It is important to consult your insurance plan documents or contact your insurance provider for detailed guidelines and instructions.

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What is prior authorizationpre-service review?

Prior authorization/pre-service review is a process used by health insurance companies to determine if a specific medical service or medication is necessary before it is provided to the patient.

Who is required to file prior authorizationpre-service review?

Healthcare providers such as physicians, hospitals, and clinics are required to file for prior authorization/pre-service review.

How to fill out prior authorizationpre-service review?

To fill out prior authorization/pre-service review, healthcare providers need to submit specific forms and documents related to the requested medical service or medication to the insurance company for review.

What is the purpose of prior authorizationpre-service review?

The purpose of prior authorization/pre-service review is to ensure that the medical services or medications being requested are medically necessary and appropriate, helping to control costs and prevent unnecessary procedures.

What information must be reported on prior authorizationpre-service review?

Information that must be reported on prior authorization/pre-service review includes patient information, healthcare provider information, details of the requested medical service or medication, and supporting medical documentation.