HI AlohaCare Request for Prior Authorization/Notification Form 2008-2025 free printable template
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REFERRAL/PRIOR AUTHORIZATION/NOTIFICATION REQUEST FORM Medical Management Prior Auth Line: (808) 973-1657 MEMBER ID: 1357 Kaplan Blvd, Suite 1250, Honolulu, HI 96814 Phone: 973-1650 (Oahu) or 1-800-434-1002
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How to fill out alohacare prior authorization form
How to fill out HI AlohaCare Request for Prior Authorization/Notification Form
01
Obtain the HI AlohaCare Request for Prior Authorization/Notification Form from the AlohaCare website or your healthcare provider.
02
Fill in the patient's information including name, date of birth, and member ID number.
03
Provide details of the medical service, procedure, or medication being requested.
04
Include the name and contact information of the healthcare provider submitting the request.
05
Attach any relevant medical records or documentation that support the request.
06
Review the form for completeness and accuracy.
07
Submit the completed form via fax, mail, or electronically to AlohaCare as instructed on the form.
Who needs HI AlohaCare Request for Prior Authorization/Notification Form?
01
Patients seeking coverage for specific medical services or treatments.
02
Healthcare providers who need to request prior authorization for their patients.
03
Individuals enrolled in AlohaCare who are undergoing certain procedures or receiving specific medications.
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What is HI AlohaCare Request for Prior Authorization/Notification Form?
The HI AlohaCare Request for Prior Authorization/Notification Form is a document used to request approval from AlohaCare for specific medical services, procedures, or medications before they are provided to ensure they meet medical necessity criteria.
Who is required to file HI AlohaCare Request for Prior Authorization/Notification Form?
Healthcare providers, including doctors and medical facilities, are required to file the HI AlohaCare Request for Prior Authorization/Notification Form on behalf of their patients who are AlohaCare members.
How to fill out HI AlohaCare Request for Prior Authorization/Notification Form?
To fill out the HI AlohaCare Request for Prior Authorization/Notification Form, providers should complete all required fields, including patient information, details of the requested service, medical necessity justification, and any supporting documentation needed for review.
What is the purpose of HI AlohaCare Request for Prior Authorization/Notification Form?
The purpose of the HI AlohaCare Request for Prior Authorization/Notification Form is to ensure that members receive medically necessary services that have been evaluated prior to provision, which helps manage costs and promotes appropriate use of healthcare resources.
What information must be reported on HI AlohaCare Request for Prior Authorization/Notification Form?
The following information must be reported on the HI AlohaCare Request for Prior Authorization/Notification Form: patient demographics (name, date of birth, insurance ID), details of the requested service (type, date, provider), medical necessity criteria, and any relevant clinical information or supporting documentation.
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