IA 470-0829 2020-2025 free printable template
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Fax completed form to: (515) 7250938Dental Request for Prior Authorization
Please complete electronically, accuracy is important.
1. Patient Name (Last)(First)M.I.4. Dispensing Provider Name5. Provider
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How to fill out IA 470-0829
01
Gather all necessary personal information including your name, address, and contact details.
02
Obtain relevant documentation to support your application, such as proof of service or other necessary forms.
03
Fill out Section 1 by providing accurate information about your military service.
04
Complete Section 2, ensuring all required fields are filled and any additional information is provided.
05
Double-check all entries for accuracy and completeness.
06
Sign and date the form at the designated area.
07
Submit the completed form either electronically or by mail according to the provided instructions.
Who needs IA 470-0829?
01
Individuals who are applying for specific military benefits.
02
Service members who need to update their personal information related to military status.
03
Veterans seeking assistance or benefits that require official documentation.
04
Family members of service members who are entitled to certain benefits.
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People Also Ask about
Does Iowa Medicaid require prior authorization?
Prior authorization is required for certain services and supplies. Submission of a prior authorization request form along with all supporting documentation is necessary to obtain these services and/or supplies: Durable Medical Equipment (DME) - Augmentative, Vision, Hearing.
What is the phone number for Medicaid DHS in Iowa?
Call and request from: DHS Contact Center – 1-855-889-7985.
How can I check the status of my food stamp case Iowa?
If you submitted an online application, you can Check Your Status online. If you mailed your application or supporting documentation contact the SNAP Retailer Service Center at 1-877-823-4369 to find out the status of your application.
Does Iowa Total Care require prior authorization?
Iowa Total Care uses prior authorizations to ensure that all care delivered to our members is medically necessary and appropriate based on the member's type and severity of condition.
What is the Medicaid appeal form for Iowa?
Form 470-5526 shall be completed by the Medicaid member or their parent, if the member is a minor. The member and the authorized representative must both sign the form. Once completed, the form should be submitted to the Medicaid member's MCO, if for a managed care appeal, or to HHS, if for a state fair hearing.
What is the authorized representative form for Medicaid in Iowa?
Clients may use Form 470-3948 when there is a need to designate a personal representative. A "personal representative" is someone designated by another as standing in the other's place or representing the other's interest for one or more purposes. Record of Disclosure of Health Information, Form 470-4015.
How do I contact DHS Iowa?
For problems or concerns regarding your local DHS office contact the Central Office at 1-800-972-2017 or by email at contactdhs@dhs.state.ia.us.
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What is IA 470-0829?
IA 470-0829 is a form used for reporting certain tax-related information to the Iowa Department of Revenue.
Who is required to file IA 470-0829?
Taxpayers who are subject to specific Iowa tax regulations and who meet certain criteria are required to file IA 470-0829.
How to fill out IA 470-0829?
To fill out IA 470-0829, you must provide personal identification information, income details, and any other required financial information as specified in the form's instructions.
What is the purpose of IA 470-0829?
The purpose of IA 470-0829 is to collect information needed to administer and enforce Iowa's tax laws effectively.
What information must be reported on IA 470-0829?
The information that must be reported on IA 470-0829 includes taxpayer identification details, types of income, deductions, and any relevant tax credits.
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