Get the free OUTPATIENT IMAGING PRIOR AUTHORIZATION

BODY PART TO BE TESTED 2. PLEASE CHECK TEST TO BE PERFORMED MRI SCAN with contrast CPT MRI SCAN without contrast CPT CT SCAN with contrast CPT CT SCAN without contrast CPT CTA Coronary arteries CPT 3. OUTPATIENT IMAGING PRIOR AUTHORIZATION FAX REQUEST FORM Fax number at 567-661-0844 or Toll Free at 844-282-4904 Phone number toll free at 800 891-2520 or 419 887-2520 Attention Paramount U/CM Dept. DATE OF REQUEST DATE OF PROCEDURE MEMBER NAME DOB PARAMOUNT MEMBER ID NUMBER ORDERING PHYSICIAN...

How to fill out outpatient imaging prior authorization

How to fill out outpatient imaging prior authorization

1. Step 1: Collect all necessary information such as patient's demographic details, insurance information, and referring physician's details.
2. Step 2: Determine the specific requirements of the insurance company for outpatient imaging prior authorization.
3. Step 3: Complete the prior authorization form provided by the insurance company. Ensure that all required fields are filled accurately.
4. Step 4: Attach the relevant supporting documentation, such as the physician's referral, medical records, and any additional documents requested by the insurance company.
5. Step 5: Submit the completed prior authorization form and supporting documents to the designated department of the insurance company via fax, email, or online portal.
6. Step 6: Keep a copy of the submitted documents for your records.
7. Step 7: Wait for the insurance company's response. They will either approve, deny, or request additional information for the prior authorization.
8. Step 8: If the prior authorization is approved, schedule the outpatient imaging as per the guidelines specified by the insurance company.
9. Step 9: If the prior authorization is denied or additional information is requested, follow the instructions provided by the insurance company to address any issues or provide the requested information.
10. Step 10: Monitor the status of the prior authorization request through regular communication with the insurance company. Follow up if necessary.

Who needs outpatient imaging prior authorization?

1. Patients who have health insurance coverage
2. Patients who require outpatient imaging services such as X-rays, CT scans, MRIs, ultrasound, etc.
3. Patients whose insurance policies require prior authorization for outpatient imaging
4. Physicians and healthcare providers who need to initiate outpatient imaging procedures for their patients
5. Any party responsible for arranging and managing healthcare services and costs, such as insurance companies, medical facilities, or third-party administrators.

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