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Clear Form DHS-4159-ENG Children's Therapeutic Services and Supports 10-11 ASSIGNED NUMBER FROM MN ITS Authorization Form Use this form in addition to the MN ITS Authorization Request transaction
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What is kepro fax retro auth?
Kepro fax retro auth is a form used to request retro authorization for healthcare services.
Who is required to file kepro fax retro auth?
Healthcare providers are required to file kepro fax retro auth for retro authorization of services.
How to fill out kepro fax retro auth?
To fill out kepro fax retro auth, providers need to provide patient information, service details, and justification for retro authorization.
What is the purpose of kepro fax retro auth?
The purpose of kepro fax retro auth is to obtain retro authorization for healthcare services that were provided but not pre-authorized.
What information must be reported on kepro fax retro auth?
Information such as patient name, date of service, service provided, and reason for retro authorization must be reported on kepro fax retro auth.
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