OH CareSource Medicaid Provider Prior Authorization Request Form 2013 free printable template

Phone: 1-800-488-0134 Fax: 1-888-752-0012 Ohio Provider Medical Prior Authorization Request Form PATIENT INFORMATION ? Routine ? Urgent (72 hours) Date of Request Member ID # Member s Last Name First

How to fill out OH CareSource Medicaid Provider Prior Authorization

How to fill out OH CareSource Medicaid Provider Prior Authorization Request

1. Gather all necessary patient information, including name, date of birth, and Medicaid ID number.
2. Collect details about the requested service or procedure, including CPT/HCPCS codes.
3. Provide clinical information that justifies the need for the service, such as diagnosis and treatment history.
4. Complete the OH CareSource Medicaid Provider Prior Authorization Request form with the gathered information.
5. Review the form for accuracy and completeness before submitting it.
6. Submit the completed form to the appropriate OH CareSource contact, either via fax or electronically.
7. Follow up to confirm that the request has been received and to check the status of the authorization.

Who needs OH CareSource Medicaid Provider Prior Authorization Request?

1. Healthcare providers who are seeking authorization for services or procedures for their Medicaid patients.
2. Patients who require specific medical services that need prior approval from OH CareSource.
3. Organizations and facilities that plan to bill Medicaid for services that require prior authorization.

People Also Ask about

Is Ohio Medicaid the same as CareSource?

Medicaid health care coverage is available for eligible Ohioans with low income, pregnant women, infants and children, older adults and individuals with disabilities. CareSource Medicaid is available across the state of Ohio. When you apply for Ohio Medicaid, you can choose CareSource as your managed care plan.

Who handles submitting a request for prior authorization?

Who is responsible for obtaining prior authorization? The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider.

Is prior authorization the same as preauthorization?

What is Prior Authorization? Prior authorization (also called “preauthorization” and “precertification”) refers to a requirement by health plans for patients to obtain approval of a health care service or medication before the care is provided.

How do I submit a prior authorization to CareSource Ohio?

Providers can obtain prior authorization for emergency admissions via the provider portal, fax or by calling Provider Services at 1-800-488-0134. Written prior authorization requests should be submitted on the Medical Prior Authorization Request Form.

Who sends the prior authorization form?

Under prior authorization, the provider or supplier submits the prior authorization request and receives the decision before services are rendered.

How do I write a prior authorization request?

The following information is generally required for all prior authorization letters. The demographic information of the patient (name, date of birth, insurance ID number and more) Provider information (both referring and servicing provider) Requested service/procedure along with specific CPT/HCPCS codes.

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What is OH CareSource Medicaid Provider Prior Authorization Request?

The OH CareSource Medicaid Provider Prior Authorization Request is a formal document that healthcare providers must submit to obtain approval for specific medical services, procedures, or medications for patients enrolled in the CareSource Medicaid program.

Who is required to file OH CareSource Medicaid Provider Prior Authorization Request?

Healthcare providers, including doctors, specialists, and facilities that administer services or treatments to patients within the CareSource Medicaid program, are required to file the OH CareSource Medicaid Provider Prior Authorization Request.

How to fill out OH CareSource Medicaid Provider Prior Authorization Request?

To fill out the OH CareSource Medicaid Provider Prior Authorization Request, providers must complete the designated form with accurate patient information, specify the requested services, include relevant clinical information or documentation, and submit the request according to CareSource guidelines.

What is the purpose of OH CareSource Medicaid Provider Prior Authorization Request?

The purpose of the OH CareSource Medicaid Provider Prior Authorization Request is to ensure that the proposed medical services or treatments are medically necessary and align with the established care protocols before the services are rendered.

What information must be reported on OH CareSource Medicaid Provider Prior Authorization Request?

The information that must be reported on the OH CareSource Medicaid Provider Prior Authorization Request includes patient demographics, provider details, service or treatment requested, diagnosis codes, and any supporting medical documentation.