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Bariatric Surgery (Medical Policy IV19) Commercial PreAuthorization (PA) Request Form Please refer to medical policy criteria on providers.bluecrossmn.com for clinical review criteria prior to submissionEffective
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01
Obtain the bariatric surgery communication pre-authorization request form from the appropriate medical facility or insurance provider.
02
Fill out all required fields on the form, including patient information, provider information, procedure details, and any supporting documentation.
03
Verify that all information provided is accurate and up-to-date.
04
Submit the completed form to the insurance provider or medical facility for review and approval.
05
Follow up with the provider or insurance company to confirm receipt and to check on the status of the pre-authorization request.

Who needs bariatric-surgery-comm-pre-auth-request-form-med?

01
Patients who are seeking to undergo bariatric surgery and require pre-authorization from their insurance provider.
02
Medical providers who are performing bariatric surgery and need to obtain pre-authorization for the procedure.
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This form is a request for pre-authorization for bariatric surgery.
Patients seeking to undergo bariatric surgery are required to file this form.
The form must be filled out with all relevant medical information and supporting documents.
The purpose of this form is to request pre-authorization for bariatric surgery from the insurance provider.
The form must include medical history, physician's notes, test results, and reason for surgery.
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