Get the free Generic Pre-certification Request Form - 09/11 - HMSA.com

HMSA PRE-CERTIFICATION REQUEST Please fax completed form to 808 944-5611 Or Mail to HMSA Medical Management Department P. O. Box 2001 Honolulu Hawaii 96805-2001 Phone Nos 808 948-6464 Oahu 800 344-6122 Neighbor Island Precertification Request Payment Determination Request HMO Administrative Review For HMO members check HMO Administrative Review box if services are being performed by an In-State Nonparticipating or Out-Of State Provider PROVIDER C...

How to fill out generic pre-certification request form

How to fill out a generic pre-certification request form:

1. Start by entering your personal information such as name, address, phone number, and email.
2. Next, provide details about the procedure or treatment you are requesting pre-certification for. Include the name of the procedure, the diagnosis, and any supporting documentation or medical records.
3. Indicate the date and time of the proposed procedure, as well as the healthcare provider who will be performing it.
4. Provide information about your insurance coverage, including your policy number, group number, and the name of your insurance company. You may also need to include information about any other insurance policies you have.
5. If you have any special requests or additional information to include, make sure to add it in the designated section.
6. Review the form for completeness and accuracy before submitting it to the appropriate party.

Who needs a generic pre-certification request form:

1. Individuals who are planning to undergo a medical procedure or treatment that requires pre-authorization from their insurance company.
2. Patients who have received a recommendation for a specific procedure from their healthcare provider and want to ensure it is covered by their insurance.
3. Anyone who wants to avoid unexpected healthcare expenses by obtaining pre-approval from their insurance company before undergoing a procedure.

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What is generic pre-certification request form?

The generic pre-certification request form is a document that is used to request pre-certification for a generic drug before it can be prescribed or dispensed.

Who is required to file generic pre-certification request form?

The healthcare provider or pharmacist who wishes to prescribe or dispense a generic drug is required to file the generic pre-certification request form.

How to fill out generic pre-certification request form?

To fill out the generic pre-certification request form, you will need to provide information about the patient, the drug being requested, and any relevant medical history or documentation. You will also need to include your contact information and any supporting materials.

What is the purpose of generic pre-certification request form?

The purpose of the generic pre-certification request form is to ensure that the generic drug being requested is medically necessary and appropriate for the patient's condition. It helps to determine whether the drug will be covered by insurance or if prior authorization is needed.

What information must be reported on generic pre-certification request form?

The generic pre-certification request form typically requires information such as the patient's name and demographic details, the drug name and dosage, the prescribing healthcare provider's information, and any supporting medical documentation.