PEHP Health & Benefits Prior Authorization for Anesthesia Services for Dental Procedures Under Medical 2018 free printable template

PRIOR AUTHORIZATION for ANESTHESIA SERVICES for DENTAL PROCEDURES under MEDICAL For authorization, pleasecompletethisform, includepatientchart notestodocumentinformationandFAXtothePEHPPrior AuthorizationDepartmentat(801)3667449ormailto:560East200SouthSaltLakeCity,UT84102.

How to fill out PEHP Health Benefits Prior Authorization for Anesformsia

How to fill out PEHP Health & Benefits Prior Authorization for Anesthesia

1. Obtain the PEHP Health & Benefits Prior Authorization form from the PEHP website or request it from your healthcare provider.
2. Fill out the patient’s personal information, including full name, date of birth, and insurance ID number.
3. Provide the details of the procedure requiring anesthesia, including the date and type of procedure.
4. Indicate the specific type of anesthesia being requested (e.g., general, regional, etc.).
5. Complete the section for the referring provider's information.
6. Add any pertinent medical history or reasons for requiring the specified anesthesia.
7. Attach any additional documentation or medical records that support the request.
8. Review the completed form for accuracy before submission.
9. Submit the form via the specified method provided by PEHP, either electronically or via mail.
10. Follow up with PEHP to ensure the authorization is approved.

Who needs PEHP Health & Benefits Prior Authorization for Anesthesia?

1. Patients undergoing surgical or medical procedures that require anesthesia.
2. Healthcare providers requesting anesthesia services for their patients under PEHP insurance.

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What is PEHP Health & Benefits Prior Authorization for Anesthesia?

PEHP Health & Benefits Prior Authorization for Anesthesia is a requirement for obtaining approval from PEHP before scheduling anesthesia services to ensure they are medically necessary and covered under the health plan.

Who is required to file PEHP Health & Benefits Prior Authorization for Anesthesia?

Healthcare providers or facilities administering anesthesia services are required to file the PEHP Health & Benefits Prior Authorization for Anesthesia on behalf of their patients.

How to fill out PEHP Health & Benefits Prior Authorization for Anesthesia?

To fill out the PEHP Health & Benefits Prior Authorization for Anesthesia, providers must complete the authorization form with patient details, procedure codes, medical necessity information, and submit it to PEHP for review.

What is the purpose of PEHP Health & Benefits Prior Authorization for Anesthesia?

The purpose of PEHP Health & Benefits Prior Authorization for Anesthesia is to evaluate and confirm the medical necessity of anesthesia services before they are provided, aiming to ensure appropriate use of resources and cost containment.

What information must be reported on PEHP Health & Benefits Prior Authorization for Anesthesia?

The information that must be reported includes the patient's demographics, the specific anesthesia procedure being requested, diagnosis codes, supporting medical documentation, and the provider's details.