Get the free Foundation Authorization Request for DEXA Scan

This document is a request form for authorization to perform a DEXA scan. It collects patient information, medical necessity details, and related provider information to facilitate the authorization

How to fill out foundation authorization request for

How to fill out Foundation Authorization Request for DEXA Scan

1. Obtain the Foundation Authorization Request form from the relevant website or healthcare provider.
2. Fill in patient details including full name, date of birth, and insurance information.
3. Provide the referring physician's information, including name, contact information, and NPI number.
4. Specify the procedure needed, in this case, a DEXA scan.
5. Include relevant medical history and any supporting documentation that justifies the need for a DEXA scan.
6. Review the filled-out form for accuracy and completeness.
7. Sign and date the form where required.
8. Submit the form via email, fax, or mail to the appropriate foundation or insurance provider.
9. Follow up with the foundation or insurance provider to ensure receipt and inquire about the status of the authorization.

Who needs Foundation Authorization Request for DEXA Scan?

1. Patients who require a DEXA scan for bone density testing.
2. Individuals with risk factors for osteoporosis or fractures.
3. Patients undergoing evaluations for certain medical conditions that impact bone health.
4. Healthcare providers needing authorization for a patient’s DEXA scan submission.

People Also Ask about

Do DEXA scans need prior authorization?

Pre-Authorization Requirements: Many insurance plans require pre-authorization before a DEXA scan can be covered. This involves submitting a formal request to your insurer, often through your healthcare provider.

Why do you need a referral for a DEXA scan?

It is important you are tested as directed by your doctor. Note: bone density scans emit a very low level of radiation (much less than a standard X-ray), which is part of the reason a referral is required.

What qualifies you for a DEXA scan?

Your healthcare provider may recommend a DEXA scan to test for osteoporosis or thinning of your bones. Screening for osteoporosis is recommended for women who are 65 years old or older and for women who are 50 to 64 and have certain risk factors, such as having a parent who has broken a hip.

Do I need a requisition for a DEXA scan?

DEXA Body Composition Scans are not covered by Alberta Health Services. However, they are an excellent way to get a thorough examination of your body to measure the fat, muscle and water content. *Dexa body scans requires a requistion form from the patient's family physician.

Can I get a DEXA scan on the NHS?

Your doctor or other health professional will refer you for a DEXA scan on the NHS. You may be able to get a DEXA scan at a private hospital or clinic without a referral. But a qualified health professional will need to authorise it.

How often will insurance pay for a DEXA scan?

Part B (Medical Insurance) covers this test once every 24 months (or more often if medically necessary) if you meet one or more of these conditions: You're a woman whose doctor determines you're estrogen-deficient and at risk for osteoporosis, based on your medical history and other findings.

Can anyone request a DEXA scan?

DEXA scans look for signs of fragile bones and help assess your risk of developing fractures, while also sometimes being used to monitor the effects of treatment for osteoporosis. A referral letter from a consultant or GP is required before booking any diagnostic investigation.

For pdfFiller’s FAQs

What is Foundation Authorization Request for DEXA Scan?

The Foundation Authorization Request for DEXA Scan is a formal request process for obtaining approval from an insurance provider or healthcare entity to conduct a Dual-Energy X-ray Absorptiometry (DEXA) scan, which is used to assess bone mineral density.

Who is required to file Foundation Authorization Request for DEXA Scan?

Typically, healthcare providers, such as physicians or specialists who recommend the DEXA scan for their patients, are required to file the Foundation Authorization Request.

How to fill out Foundation Authorization Request for DEXA Scan?

To fill out the Foundation Authorization Request for DEXA Scan, healthcare providers should provide patient demographics, clinical history, the reason for the scan, and any supporting documentation that justifies the need for the procedure.

What is the purpose of Foundation Authorization Request for DEXA Scan?

The purpose of the Foundation Authorization Request for DEXA Scan is to ensure that the scan is medically necessary and to obtain prior approval from the insurance provider to facilitate coverage for the procedure.

What information must be reported on Foundation Authorization Request for DEXA Scan?

The reported information should include patient information (name, date of birth, insurance details), provider details, clinical justification for the scan, any relevant medical history, and the specific type of DEXA scan requested.