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1 Intensive Outpatient H0010 / rev 1002 ASAM Level 3. 5 Clinically Managed High-Intensity Residential Services Adults Rev 0906 ASAM Level 2. CONTACT INFORMATION Managed Care Organization Contact Phone Number Fax Number Aetna Better Health Stephanie Hargan 800 279-1878 866 669-2454 N/A 800 901-0020 for inpatient 877 434-7578 800 505-1193 for outpatient INTotal Health 855 323 5588 888 393 8978 Kaiser Virginia Fancher Sue Leech Linda Bloch 301 625-6104 855 414-1703 Magellan 800 424-4046 Optima...
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What is service authorization review form?
Service authorization review form is a document used to request authorization for a service or review of an existing authorization.
Who is required to file service authorization review form?
Service providers or individuals seeking authorization for a service are required to file the service authorization review form.
How to fill out service authorization review form?
Service authorization review form should be completed with accurate and detailed information regarding the service being requested or reviewed.
What is the purpose of service authorization review form?
The purpose of service authorization review form is to ensure that services are properly authorized and meet the necessary requirements.
What information must be reported on service authorization review form?
Information such as the type of service, reason for authorization, duration of service, and any supporting documentation must be reported on the service authorization review form.
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