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OUTOFNETWORK PRESERVICE/ PREAUTHORIZATION REQUEST FORMRequest Date. URGENT All requests marked as urgent/expedited must include supporting documentation from the physicians' office that the application
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Out-of-network pre-service refers to medical services provided by healthcare providers that are not part of an individual's health insurance plan's network.
Both healthcare providers and patients may be required to file out-of-network pre-service, depending on the specific insurance plan and circumstances.
To fill out out-of-network pre-service, healthcare providers must submit a claim form with detailed information about the services provided, the patient's insurance information, and any required documentation.
The purpose of out-of-network pre-service is to request reimbursement from the insurance company for medical services provided by healthcare providers that are not in the insurance plan's network.
Information that must be reported on out-of-network pre-service includes the healthcare provider's name and contact information, the patient's insurance ID number, the date of service, and a detailed description of the services provided.
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