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Sutter Health Sacramento Sierra Region (SH SSR) Radiology Authorization Request Form Routine & Urgent Referrals (Fax) 9166436556 or (888) 5168025 Date: Employer: MAN#: Patient Name: DOB: Plan / Product:
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How to fill out shssr radiology authorization request
How to fill out the shssr radiology authorization request:
01
Start by filling out the patient's personal information, such as their full name, date of birth, and contact details. This will ensure that the request is properly identified.
02
Provide the necessary medical information, including the reason for the radiology procedure and any relevant medical history. This will help the healthcare provider understand the context and make informed decisions.
03
Indicate the specific radiology test or procedure that is being requested. Include any additional details or special instructions that may be relevant for the healthcare provider.
04
If applicable, provide the insurance information, including the name of the insurance company and the policy number. This will help facilitate the payment process.
05
Include the date and signature of the patient or their legal guardian. This confirms their consent for the radiology procedure and acknowledges their understanding of the risks and benefits involved.
Who needs the shssr radiology authorization request?
01
Patients who require radiology procedures or tests, such as X-rays, MRIs, or CT scans, may need to fill out the shssr radiology authorization request. This ensures that the healthcare provider has the necessary information and consent before proceeding with the procedure.
02
Healthcare providers, such as radiologists or referring physicians, may also need the shssr radiology authorization request to ensure that the requested procedure is appropriate and necessary for the patient's condition. It helps in coordinating and documenting the medical care provided.
03
Insurance companies may require the shssr radiology authorization request to authorize coverage for the radiology procedure. This ensures that the requested procedure meets the insurance company's criteria for medical necessity and facilitates the billing and reimbursement process.
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What is shssr radiology authorization request?
The shssr radiology authorization request is a form that needs to be submitted in order to request authorization for radiology services.
Who is required to file shssr radiology authorization request?
Healthcare providers who wish to perform radiology services are required to file the shssr radiology authorization request.
How to fill out shssr radiology authorization request?
The shssr radiology authorization request can be filled out by providing the necessary information about the patient, the type of radiology service requested, and any other relevant details.
What is the purpose of shssr radiology authorization request?
The purpose of the shssr radiology authorization request is to obtain approval for radiology services from the relevant authorities.
What information must be reported on shssr radiology authorization request?
The shssr radiology authorization request must include information such as patient details, requested radiology services, reason for the request, and any relevant medical history.
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