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PSYCHOLOGICAL TESTING PRE-AUTHORIZATION REQUEST FORM BEHAVIORAL HEALTH SERVICES Please fax to Behavioral Health Unit 740. 699. 6255 Toll Free 1. 866. 616. 6255 All sections must be completed for timely pre-authorization consideration. Today s Date Member s ID Member s Name Date of Birth Referring Provider Phone Number Address Testing Provider Has a diagnostic interview been conducted by the requesting practitioner Date of review Yes Was rating scales and/or inventories completed No If so...
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How to fill out psychological testing pre-authorization request
How to fill out psychological testing pre-authorization request
01
Gather all necessary documentation, such as referral forms and medical records.
02
Contact the insurance provider to verify the specific requirements for the pre-authorization request.
03
Complete the pre-authorization request form, ensuring all information is accurate and complete.
04
Include any relevant assessment or testing recommendations from the attending psychologist.
05
Attach any supporting documentation, such as previous test results or treatment plans.
06
Submit the completed pre-authorization request either online, through email, or by mail.
07
Wait for the insurance provider's response, which may include approval, denial, or a request for additional information.
08
If approved, schedule the psychological testing as per the guidelines provided by the insurance provider.
09
If denied, review the reasons for denial and consider filing an appeal, if applicable.
10
Follow up with the insurance provider to ensure proper payment and coverage for the psychological testing.
Who needs psychological testing pre-authorization request?
01
Individuals seeking psychological testing services.
02
Psychiatrists, psychologists, or other mental health professionals requiring pre-authorization for their patients' psychological testing.
03
Insurance companies and their representatives involved in the pre-authorization process.
04
Healthcare providers or clinics offering psychological testing as part of their services.
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What is psychological testing pre-authorization request?
It is a request submitted to obtain approval for psychological testing services before they are provided.
Who is required to file psychological testing pre-authorization request?
Healthcare providers or facilities that plan to conduct psychological testing services.
How to fill out psychological testing pre-authorization request?
You must complete the request form with detailed information about the patient, the tests to be conducted, and the medical necessity for the testing.
What is the purpose of psychological testing pre-authorization request?
The purpose is to ensure that the psychological testing services are medically necessary and will be covered by the insurance provider.
What information must be reported on psychological testing pre-authorization request?
You must include patient demographics, medical history, specific tests requested, and justification for the testing.
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