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PRIOR AUTHORIZATION FAX-FORM Kentucky Medicaid Home Health Care Services Program Page 1 of 2 Map 130 (3Rev. 0 /10) DATE FORM COMPLETED Complete all questions.
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What is map 130 prior authorization?
The map 130 prior authorization is a form that needs to be submitted to obtain approval for certain medical services or treatments before they are provided.
Who is required to file map 130 prior authorization?
Healthcare providers, such as doctors, hospitals, or clinics, are required to file map 130 prior authorization.
How to fill out map 130 prior authorization?
Map 130 prior authorization can be filled out by providing all the necessary information about the patient, the treatment needed, and any supporting documentation.
What is the purpose of map 130 prior authorization?
The purpose of map 130 prior authorization is to ensure that the requested medical services are necessary and appropriate for the patient's condition.
What information must be reported on map 130 prior authorization?
Information such as patient's demographics, medical history, diagnosis, treatment plan, and healthcare provider's information must be reported on map 130 prior authorization.
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