Get the free CenCal Prior Authorization Fax Form2017.docx
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To submit online visit https //cencal.careportal.com. If Urgent Please Call Referring Provider Information 1 Date request submitted 3 Provider 2 Office contact person 4 Physician Name 8 E-mail MM/ DD/ YYYY 6 Phone ID NPI Specialty XXX XXX - XXXX 7 Fax Address Rendering Facility/Practice Information 9 Facility/Practice 11 Phone 14 Member name ID 12 Fax NPI of Birth List procedure s Ordered 18 Procedures 19 CPT code 20 Modifier 21 Units Clinical indications for the ordered exams e.g. signs...
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What is cencal prior authorization fax?
Cencal prior authorization fax is a form that must be submitted to Cencal Health for approval before receiving certain medical services or treatments.
Who is required to file cencal prior authorization fax?
Healthcare providers and facilities are required to file Cencal prior authorization fax when seeking approval for certain medical services or treatments.
How to fill out cencal prior authorization fax?
Cencal prior authorization fax must be filled out completely and accurately, including all required patient and treatment information.
What is the purpose of cencal prior authorization fax?
The purpose of Cencal prior authorization fax is to ensure that medical services or treatments meet Cencal Health's coverage criteria and are medically necessary for patients.
What information must be reported on cencal prior authorization fax?
Information that must be reported on Cencal prior authorization fax includes patient demographics, diagnosis codes, treatment codes, and supporting medical documentation.
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