Sunshine Health Inpatient Medicaid Prior Authorization Fax Form free printable template
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INPATIENT Complete and Fax to: 1-866-796-0526 Prior Authorization Fax Form * INDICATES REQUIRED FIELD Date of Birth MEMBER INFORMATION Member ID/Medicaid ID * Last Name, First *0323* This is a standard
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How to fill out inpatient prior authorization fax
How to fill out Sunshine Health Inpatient Medicaid Prior Authorization Fax
01
Obtain the Sunshine Health Inpatient Medicaid Prior Authorization Fax form from the Sunshine Health website or your healthcare provider.
02
Fill in the patient's demographic information, including name, date of birth, and Medicaid ID number.
03
Provide details of the requested inpatient service, including the diagnosis code and description.
04
Include the start and expected end date of the inpatient stay.
05
Add information about the referring physician, including their name and contact information.
06
Attach any necessary clinical documentation that supports the need for the inpatient service.
07
Review the completed form for accuracy and completeness.
08
Fax the completed form to the designated Sunshine Health fax number, ensuring to keep a copy for your records.
Who needs Sunshine Health Inpatient Medicaid Prior Authorization Fax?
01
Patients seeking inpatient hospital treatment covered by Medicaid.
02
Healthcare providers requiring prior authorization for inpatient services for their patients.
03
Facilities that need to confirm coverage before admitting patients under Sunshine Health's Medicaid program.
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What is Sunshine Health Inpatient Medicaid Prior Authorization Fax?
Sunshine Health Inpatient Medicaid Prior Authorization Fax is a document required by Sunshine Health to obtain prior authorization for inpatient services under Medicaid. It allows healthcare providers to request approval for specific services before they are rendered.
Who is required to file Sunshine Health Inpatient Medicaid Prior Authorization Fax?
Healthcare providers and facilities that wish to provide inpatient services to Medicaid recipients must file the Sunshine Health Inpatient Medicaid Prior Authorization Fax.
How to fill out Sunshine Health Inpatient Medicaid Prior Authorization Fax?
To fill out the Sunshine Health Inpatient Medicaid Prior Authorization Fax, providers must complete the required fields with the patient's information, details of the requested service, medical necessity justification, and any other relevant documentation before submitting it to Sunshine Health.
What is the purpose of Sunshine Health Inpatient Medicaid Prior Authorization Fax?
The purpose of the Sunshine Health Inpatient Medicaid Prior Authorization Fax is to ensure that the proposed inpatient services are medically necessary and meet the criteria for coverage under the Medicaid program.
What information must be reported on Sunshine Health Inpatient Medicaid Prior Authorization Fax?
The information that must be reported includes patient demographics, provider information, details of the requested inpatient services, clinical information justifying the need for admission, and any relevant insurance details.
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