Get the free ARUP-FORM-1222 Exome Pre-Auth
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THISISNOTATESTREQUESTFORM.
Pleasefilloutthisformandsubmititwiththetestrequestformorelectronicpackinglist.INSURANCEPREAUTHORIZATIONFOREXOMESEQUENCING
INSTRUCTIONS:IftheorderingfacilitywouldlikeARUPLaboratoriestoobtaininsurancepreauthorizationpriortoperformingExome
Sequencing,
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How to fill out arup-form-1222 exome pre-auth
How to fill out arup-form-1222 exome pre-auth
01
Step 1: Begin by gathering all the necessary information and documentation required to fill out the ARUP-form-1222 Exome Pre-Authorization form.
02
Step 2: Start by filling out the patient's personal information section, including name, date of birth, gender, and contact information.
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Step 3: Move on to the referring provider's information section, which includes their name, contact details, and their NPI number.
04
Step 4: Fill out the insurance information section, providing the name of the insurance company, policy number, and any additional required details.
05
Step 5: Provide a detailed clinical history and indication for ordering the exome pre-authorization, including any relevant medical information or supporting documentation.
06
Step 6: Fill out the laboratory tests requested section, specifying the type of exome analysis required and any additional tests necessary.
07
Step 7: Include any additional relevant information or documentation that may be required for the pre-authorization process.
08
Step 8: Review the completed form for accuracy, ensuring that all information is entered correctly and legibly.
09
Step 9: Submit the ARUP-form-1222 Exome Pre-Authorization form to the appropriate entity or insurance company as per their provided instructions.
10
Step 10: Wait for the pre-authorization decision and follow up with the insurance company or referring provider as necessary.
Who needs arup-form-1222 exome pre-auth?
01
The ARUP-form-1222 Exome Pre-Authorization is typically required for individuals who are planning to undergo an exome sequencing analysis.
02
This pre-authorization is necessary to ensure that the cost of the exome analysis will be covered by the patient's insurance provider.
03
It is generally required by individuals who have specific medical indications or suspected genetic conditions that can be diagnosed through exome sequencing.
04
The requirement may vary depending on the insurance provider and the patient's individual policy coverage, so it is best to consult with the insurance company or referring provider to determine if the pre-authorization is necessary.
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What is arup-form-1222 exome pre-auth?
ARUP-form-1222 Exome Pre-Authorization is a form used to request pre-approval for exome sequencing tests outlined by ARUP Laboratories.
Who is required to file arup-form-1222 exome pre-auth?
Healthcare providers, specifically physicians ordering exome sequencing tests, are required to file ARUP-form-1222 Exome Pre-Authorization.
How to fill out arup-form-1222 exome pre-auth?
To fill out ARUP-form-1222, ensure you provide patient information, test information, clinical rationale, and any relevant medical history as specified in the form's guidelines.
What is the purpose of arup-form-1222 exome pre-auth?
The purpose of ARUP-form-1222 Exome Pre-Authorization is to obtain approval from insurance providers for the coverage of exome sequencing testing prior to the actual test being performed.
What information must be reported on arup-form-1222 exome pre-auth?
On ARUP-form-1222, you must report patient demographics, details of the requested test, clinical information justifying the test, and relevant history.
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