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Recertification for Specialty Drug Management for Blue Cross Blue Shield of Arizona Provider Education 2015 encore healthcare. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY

How to fill out precertification for specialty

How to fill out precertification for specialty

1. To fill out precertification for specialty, follow these steps:
2. Gather all the necessary information: patient details, referring physician information, date of service, requested service or procedure, medical records, and any supporting documents.
3. Contact the insurance company or third-party payer to verify if precertification is required for the specific specialty procedure or service.
4. Fill out the precertification form provided by the insurance company. Make sure to accurately enter all the required information.
5. Attach any relevant supporting documents such as medical records, diagnostic test results, or physician notes.
6. Submit the completed form and supporting documents to the insurance company or third-party payer through the designated channels, which could be online submission, fax, or mail.
7. Wait for the precertification decision from the insurance company. It may take some time for them to review the request and provide approval or denial.
8. If the precertification is approved, keep a copy of the approval documentation for reference.
9. If the precertification is denied, review the reasons for denial and consider appealing the decision if appropriate.

Who needs precertification for specialty?

1. Precertification for specialty is usually required by:
2. - Patients who have insurance coverage that mandates precertification for certain specialty procedures or services.
3. - Patients seeking specialized medical treatments or procedures that are deemed as high-cost or require additional review by the insurance company.
4. - Healthcare providers or facilities performing specialty procedures or services, as they need to ensure payment approval from the insurance company before providing the service to the patient.

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What is precertification for specialty?

Precertification for specialty is the process of obtaining approval from a health insurance company before receiving certain medical treatments from a specialist.

Who is required to file precertification for specialty?

Patients who have health insurance that requires precertification for specialty services are typically required to file for precertification.

How to fill out precertification for specialty?

To fill out precertification for specialty, patients must provide information about the specialist they plan to see, the reason for the specialist visit, and any other relevant medical history.

What is the purpose of precertification for specialty?

The purpose of precertification for specialty is to ensure that the treatment is medically necessary and meets the criteria set by the health insurance company.

What information must be reported on precertification for specialty?

Information that must be reported on precertification for specialty typically includes patient demographics, diagnosis, treatment plan, and provider information.