Get the free PET Scan Precertification Fax Form - The Radiology Clinic

An Independent Licensee of the Blue Cross and Blue Shield Association. PET SCAN RECERTIFICATION FAX FORM 169 Myers Corners Road Happiness Falls, NY 12590 Telephone: 866 803-8002 Fax: 866 466-6964

How to fill out pet scan precertification fax

How to Fill Out Pet Scan Precertification Fax:

1. Gather all necessary information: Before starting to fill out the precertification fax, make sure you have all the relevant details at your disposal. This may include the patient's personal information (name, date of birth, and contact information), insurance details, referring physician's information, and the purpose of the PET scan.
2. Begin with the patient details: Start by providing the patient's full name and date of birth. Double-check for any spelling errors or typos to ensure accuracy.
3. Include the patient's insurance information: Write down the patient's insurance provider's name, policy number, and group number. Verify that all the information is correct and up to date.
4. Specify the referring physician: Indicate the name, contact information, and specialty of the referring physician who has ordered the PET scan. This allows the insurance company to identify the responsible doctor.
5. Provide clinical information: Describe the medical condition or symptoms that require the PET scan. Be specific and include any relevant diagnostic codes or medical terminology to support the necessity of the procedure.
6. Include the CPT code: Each medical procedure has a specific Current Procedural Terminology (CPT) code used for billing and identification purposes. Find the appropriate CPT code for the PET scan and include it in the fax.
7. Attach supporting documents: If there are any supplementary documents required by the insurance company, such as medical records or prior test results, make sure to include them with the fax. These documents can help demonstrate the medical necessity of the PET scan.
8. Send the fax to the insurance company: Once you have completed all the necessary sections of the precertification fax, double-check for any errors or missing information. Then, securely fax the document to the insurance company's designated fax number.

Who Needs Pet Scan Precertification Fax:

1. Patients undergoing a PET scan: Individuals who are scheduled to undergo a PET scan and wish to have the procedure covered by their insurance may require a precertification fax. This allows the insurance company to review and approve the necessity of the scan before the procedure takes place.
2. Referring physicians: Doctors who have ordered a PET scan for their patients may need to complete the precertification fax to provide the insurance company with the relevant information and supporting documentation.
3. Insurance companies: The pet scan precertification fax serves as a tool for insurance companies to assess the medical necessity of the PET scan and determine whether it should be covered by the patient's insurance. They review the provided information and make the final decision on approval or denial of coverage.

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What is pet scan precertification fax?

PET scan precertification fax is a form that needs to be submitted to obtain authorization for a PET scan procedure.

Who is required to file pet scan precertification fax?

Medical providers or facilities performing the PET scan procedure are required to file the precertification fax.

How to fill out pet scan precertification fax?

The form must be completed with patient information, provider details, reason for the procedure, and insurance information.

What is the purpose of pet scan precertification fax?

The purpose of the precertification fax is to obtain approval from the insurance provider for the PET scan procedure.

What information must be reported on pet scan precertification fax?

Patient details, medical history, reason for the procedure, provider information, insurance details, and any relevant clinical information.