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AUTHORIZATION REQUEST FORM General Rules Urgent and Emergency Care DO NOT require Prior Authorization. Excluded services are not covered. Excluded services will be denied as a noncovered benefit,

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How to fill out urgent and emergency care

01

Call 911 or go to the nearest emergency room if you have a life-threatening emergency.

02

For urgent care, contact your primary care physician or visit an urgent care clinic.

03

Provide your medical history, insurance information, and any symptoms or concerns to the healthcare provider.

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Follow the recommendations and treatment plan provided by the healthcare provider.

Who needs urgent and emergency care?

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Anyone experiencing a life-threatening medical emergency such as chest pain, difficulty breathing, severe bleeding, or loss of consciousness.

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Individuals with urgent medical needs that cannot wait for a regular doctor's appointment, such as fevers, minor injuries, or infections.

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What is urgent and emergency care?

Urgent and emergency care refers to medical attention that is needed immediately for serious illnesses or injuries.

Who is required to file urgent and emergency care?

Healthcare providers are required to file urgent and emergency care.

How to fill out urgent and emergency care?

Urgent and emergency care can be filled out by documenting the medical treatment provided, patient information, and details of the emergency situation.

What is the purpose of urgent and emergency care?

The purpose of urgent and emergency care is to provide immediate medical attention to individuals in critical conditions.

What information must be reported on urgent and emergency care?

Information such as patient details, medical treatment provided, date and time of emergency, and healthcare provider information must be reported on urgent and emergency care forms.

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