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How do I fill this out?
To fill out this form, start by entering the member's ID and name at the top. Next, provide detailed information regarding the requesting and performing providers. Finally, ensure all required fields are completed and the form is signed before submitting.
How to fill out the Advent Health Provider Prior Authorization Form?
1
Enter the member's ID and name.
2
Provide details of the requesting and performing providers.
3
Specify the dates of service requested.
4
Complete the CPT/HCPCS and ICD codes as necessary.
5
Sign the form before submission.
Who needs the Advent Health Provider Prior Authorization Form?
1
Healthcare providers needing authorization for patient services.
2
Patients requiring procedures that need insurance approval.
3
Administrative staff managing patient equivalency requests.
4
Billing departments processing insurance claims.
5
Specialists seeking prior approval for treatment plans.
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What are the instructions for submitting this form?
Submit this form via fax to 1.855.328.0059 or via Toll-Free Phone at 1.844.522.5278. Online submission can be done through myAHplan.com. Ensure accurate completion to avoid processing delays.
What are the important dates for this form in 2024 and 2025?
For 2024, the submission deadlines are by the end of each quarter. In 2025, specific deadlines will be established as per annual review processes. Stay updated with changes that may affect benefit approvals.
What is the purpose of this form?
This form is designed to obtain pre-approval for certain medical services from Advent Health. By gathering necessary information, it helps facilitate access to vital healthcare services. Proper completion and submission ensure that providers and patients adhere to the required medical authorization processes.
Tell me about this form and its components and fields line-by-line.
- 1. MEMBER ID#: Identification number for the patient receiving services.
- 2. MEMBER NAME: First and last name of the member.
- 3. REQUESTING PROVIDER NAME: Name of the provider requesting authorization.
- 4. PROVIDER CONTACT NAME: Contact person for the requesting provider.
- 5. FACILITY/SUPPLIER: The name of the facility or supplier providing services.
- 6. PLACE OF SERVICE: The location where the service will occur, e.g., office or hospital.
- 7. CPT/HCPCS CODE(S): Codes indicating the type of service or procedure requested.
- 8. ICD CODE(S): Diagnostic codes related to the patient's condition.
What happens if I fail to submit this form?
Failure to submit this form may result in delayed or denied medical services. Providers cannot proceed with requested procedures without necessary authorizations. It is crucial to ensure timely submission to avoid negative impacts on patient care.
- Delayed Procedures: Services may be postponed leading to potential health risks.
- Denial of Coverage: Insurance may deny coverage for unapproved services.
- Increased Financial Burden: Patients might incur out-of-pocket expenses for unauthorized treatments.
How do I know when to use this form?
- 1. Surgical Procedures: Request authorization for scheduled surgeries.
- 2. Specialist Referrals: Ensure coverage for referrals to specialists.
- 3. Advanced Diagnostic Testing: Authorization needed for certain imaging and lab tests.
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