Get the free Hospice precertification request

Hospice recertification request Long term services and supports (LESS) fax number: 18552259937 Authorization number: (to be completed by Amerigroup Kansas, Inc.) Today's date: Member information Name:

How to fill out hospice precertification request

How to fill out hospice precertification request

1. To fill out a hospice precertification request, follow these steps:
2. Obtain the precertification form from the hospice provider or download it from their website.
3. Fill out the patient's demographic information, including their name, address, date of birth, and phone number.
4. Provide the patient's medical history, including any diagnoses, current medications, and previous treatments.
5. Include information about the patient's primary care physician and any specialists involved in their care.
6. Document the reason for hospice precertification, such as a terminal illness diagnosis or declining health condition.
7. Attach supporting medical documentation, including lab results, imaging reports, and physician's notes.
8. Ensure all required fields are completed accurately.
9. Submit the completed form to the hospice provider via mail, fax, or electronic submission.
10. Follow up with the hospice provider to confirm receipt of the precertification request and inquire about the status.
11. Provide any additional information or documentation as requested by the hospice provider.
12. Await the approval or denial of the precertification request from the hospice provider.
13. If approved, continue to work closely with the hospice provider to initiate the necessary hospice care services.

Who needs hospice precertification request?

1. Anyone requiring hospice care services needs a hospice precertification request.
2. This includes individuals with a terminal illness, declining health conditions, or a prognosis of six months or less to live.
3. The request is typically made by the patient, their family members, or their healthcare provider.
4. The precertification process helps ensure that the patient meets the eligibility criteria for hospice care and allows for appropriate coordination of services.

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What is hospice precertification request?

Hospice precertification request is a process of obtaining approval from a health insurance provider before a patient can receive hospice care.

Who is required to file hospice precertification request?

The healthcare provider or hospice agency providing care for the patient is required to file the hospice precertification request.

How to fill out hospice precertification request?

The hospice precertification request form must be completed with the patient's personal information, medical history, and the planned hospice care services.

What is the purpose of hospice precertification request?

The purpose of hospice precertification request is to ensure that the patient meets the criteria for hospice care and that the services provided will be covered by the insurance provider.

What information must be reported on hospice precertification request?

The hospice precertification request must include the patient's diagnosis, prognosis, recommended treatment plan, and the healthcare provider's certification of terminal illness.