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CONTAINS CONFIDENTIAL PATIENT INFORMATION Hoosier Health wise ? () Prior Authorization of Benefits (PAB) Form FAX TO PRIOR AUTHORIZATION OF BENEFITS CENTER AT (866) 408 7103 1. PATIENT INFORMATION
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How to fill out an SSB PAB fax:
01
Start by gathering all of the necessary information and documents that are needed to complete the fax. This may include personal information, contact information, and any other relevant details.
02
Next, carefully review the form and make sure you understand each section and what information needs to be provided.
03
Begin filling out the form by entering your personal details such as your name, address, and contact information.
04
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Finally, securely send the completed fax to the intended recipient using the provided fax number or instructions.
Who needs an SSB PAB fax:
01
Individuals who are required to submit certain documents or information to the SSB PAB organization.
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Anyone who wants to establish contact or communicate important information with the SSB PAB using a fax as the preferred method of communication.
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