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DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN Division of Medicaid Services DHS 106.03(4), Wis. Admin. Code F11020 (05/2013)FORWARDHEALTH PRIOR AUTHORIZATION REQUEST FOR HEARING INSTRUMENT AND
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How to fill out prior authorization request for

01
Gather all necessary information and supporting documents
02
Contact the insurance company to confirm their specific prior authorization request process
03
Complete the prior authorization form accurately and legibly
04
Include any relevant medical records or notes from healthcare providers
05
Submit the completed form and supporting documents to the insurance company for review

Who needs prior authorization request for?

01
Patients who require medication or treatment that may not be covered without prior authorization
02
Healthcare providers who want to ensure that their services or prescriptions are approved for coverage

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Prior authorization request is a process used by health insurance companies to determine if they will cover a prescribed procedure, treatment, or medication.
Typically, healthcare providers or the patient's healthcare team are required to file prior authorization requests on behalf of the patient.
To fill out a prior authorization request, the provider must complete a form provided by the insurer, including patient details, specific procedure or medication information, and clinical justification.
The purpose of a prior authorization request is to ensure that the requested treatment or medication is medically necessary and to control healthcare costs.
The information that must be reported includes patient demographic information, diagnosis codes, procedure or medication details, and supporting clinical documentation.
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