Get the free Washington Prior Authorization Fax Request Form

Washington Prior Authorization Fax Request Form Fax: 855-554-2152 Phone: 866-604-3267 Please complete all fields on the form referring to the list of services that require authorization at UHCCommunityPlan.com.

How to fill out washington prior authorization fax

How to fill out washington prior authorization fax:

1. Start by obtaining the prior authorization form from the Washington State Medicaid website or your healthcare provider. Make sure you have all the necessary information and documents before proceeding.
2. Begin filling out the form by providing your personal details, including your name, address, phone number, and date of birth. Double-check the accuracy of the information to avoid any errors.
3. Indicate the healthcare service or procedure for which you are seeking prior authorization. Include the relevant CPT (Current Procedural Terminology) codes and a brief description of the service.
4. Provide the name, contact information, and National Provider Identifier (NPI) of the healthcare provider who will be performing the service or procedure. If there is a group or clinic involved, include their details as well.
5. Include any supporting documentation that may be required, such as medical records, diagnostic reports, or treatment plans. Ensure that all attachments are securely attached to the fax.
6. Include any additional information or notes that might be helpful for the reviewer to understand the necessity of the requested service or procedure. This could include details about the patient's medical history, previous treatments, or any other relevant factors.
7. Review the completed form for accuracy and completeness one final time. Ensure that all sections have been filled out correctly and that no information is missing.
8. Once you are satisfied with the form, proceed to fax it to the designated fax number provided by your healthcare provider or the Washington State Medicaid office. Ensure the fax is sent from a reliable and properly functioning machine.

Who needs Washington prior authorization fax:

1. Healthcare providers who wish to obtain authorization for specific services or procedures for their patients from Washington State Medicaid.
2. Patients who are covered by Washington State Medicaid and require a service or procedure that requires prior authorization. This includes individuals who receive healthcare services through managed care organizations or fee-for-service programs.
3. Health insurance companies or third-party administrators who are responsible for reviewing and authorizing healthcare services on behalf of Washington State Medicaid. These entities may require the submission of a prior authorization fax for certain services.

Note: It is important to consult with your healthcare provider or Washington State Medicaid for specific instructions and requirements regarding the filling out and submission of prior authorization faxes.

For pdfFiller’s FAQs

What is washington prior authorization fax?

Washington prior authorization fax is a request form that must be submitted to obtain approval from an insurance company before receiving certain medical services or medications.

Who is required to file washington prior authorization fax?

Healthcare providers, pharmacists, or patients may be required to file washington prior authorization fax depending on the insurance company's policies.

How to fill out washington prior authorization fax?

Washington prior authorization fax should be filled out completely with all required information including patient demographics, medical necessity, and any supporting documentation.

What is the purpose of washington prior authorization fax?

The purpose of washington prior authorization fax is to obtain approval from the insurance company to ensure that medical services or medications will be covered.

What information must be reported on washington prior authorization fax?

Patient information, healthcare provider information, medical services or medications requested, medical necessity, and any supporting documentation must be reported on washington prior authorization fax.

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