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RECERTIFICATION REQUEST Formal REQUIRE MEDICAL RECORDS TO BE ATTACHED
Phone: 8887960947 Fax: 8666089860 or 8882021940Instructions:This form is for recertification requests which will be processed
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What is pre-certification request form?
The pre-certification request form is a document that must be completed and submitted prior to receiving approval for a particular service, treatment, or procedure.
Who is required to file pre-certification request form?
Healthcare providers, doctors, or patients may be required to file a pre-certification request form depending on the insurance policy and specific requirements.
How to fill out pre-certification request form?
To fill out a pre-certification request form, you will need to provide detailed information about the requested service, treatment, or procedure, along with relevant medical documentation.
What is the purpose of pre-certification request form?
The purpose of the pre-certification request form is to ensure that the requested medical services are medically necessary and meet the criteria for coverage under the insurance policy.
What information must be reported on pre-certification request form?
The pre-certification request form typically requires information such as patient demographics, diagnosis, treatment plan, and healthcare provider information.
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