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Date Requested Oklahoma fax to 800-273-1371 PHONE ONLY FOR EMERGENT REQUESTS Oklahoma Phone 800-474-1938 Texas fax to 800-438-5470 Texas Phone 800-668-8139 HMO Pre-Authorization Request Form All Services Must be Provided in Network SECTION 1 PROVIDER DATA ITEMS IN SECTION 3 REQUIRE AUTHORIZATION. ALL OTHER SERVICES DO NOT REQUIRE AUTHORIZATION Type of Service Outpatient Inpatient DME Therapy Home Health Diagnostic Test Other Type of Request Urgen...

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What is 800 668 8139 form?

The 800 668 8139 form is a tax form used for reporting certain information to the tax authorities.

Who is required to file 800 668 8139 form?

The individuals or businesses who meet the criteria set by the tax authorities are required to file the 800 668 8139 form.

How to fill out 800 668 8139 form?

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What is the purpose of 800 668 8139 form?

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