Altrua HealthShare Eligibility Form Instructions
This file provides vital information for submitting Eligibility/Pre-Authorization Requests for Altrua HealthShare. It includes essential details required for a successful submission. Ensure all requested documentation is included for prompt processing.
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How do I fill this out?
To fill out the form, start by entering your personal details, including your name and member ID. Next, provide all medical documentation related to the request. Ensure that the documentation is typed or dictated and submit the completed form to the Eligibility Department.
How to fill out the Altrua HealthShare Eligibility Form Instructions?
1
Gather all necessary personal and medical information.
2
Complete the form with accurate details and documentation.
3
Ensure documentation is typed, not handwritten.
4
Double-check all information for accuracy.
5
Submit the form through email, fax, or mail.
Who needs the Altrua HealthShare Eligibility Form Instructions?
1
Individuals seeking health services require this form to verify eligibility.
2
Medical facilities need this form to secure pre-authorization for services.
3
Healthcare providers request this form to submit eligibility requests on behalf of patients.
4
Insurance coordinators utilize this form to ensure accurate submissions for covered services.
5
Members of Altrua HealthShare fill out this form to access care services.
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What are the instructions for submitting this form?
To submit this form, email it to eligibility@altruahealthshare.org or fax it to 737-402-7752. You may also mail it to P.O. Box 90849, Austin, TX 78709-0849. Ensure that all required documentation is assembled and included before sending your submission.
What are the important dates for this form in 2024 and 2025?
Ensure you are aware of any upcoming deadlines for eligibility requests in 2024 and 2025. Dates will vary based on personal circumstances and the type of service requested. Always check with your healthcare provider for specific deadlines relevant to your situation.
What is the purpose of this form?
The purpose of this form is to facilitate the process of obtaining eligibility and pre-authorization for medical services from Altrua HealthShare. It ensures that all necessary information is collected to assess a member's eligibility for requested services. By filling out this form correctly, members expedite their access to essential healthcare services.
Tell me about this form and its components and fields line-by-line.
- 1. Eligibility Dept: Contact details for the department handling eligibility requests.
- 2. Number of Pages: Total number of pages being submitted, including cover sheets.
- 3. Review Type: Indicates the urgency level of the request, such as urgent or non-urgent.
- 4. Treating Physician: Details of the physician treating the member.
- 5. Member Information: Includes name, ID, and date of birth of the member requesting services.
- 6. Requested CPT(s): List of CPT codes for the services requested.
- 7. Associated ICD-10(s): Diagnostic codes related to the requested services.
What happens if I fail to submit this form?
Failure to submit the form can lead to delays in receiving approval for necessary medical services. This may impact your access to urgent health care. Incomplete submissions may cause your request to be rejected, requiring you to resubmit.
- Incomplete Information: Missing data can delay processing time significantly.
- Unclear Documentation: If the documentation is not clear or acceptable, it may not be considered.
- Missing Deadline: Failing to submit by the deadlines can result in not receiving services.
How do I know when to use this form?
- 1. Eligibility Confirmation: To confirm eligibility for health services before treatment.
- 2. Pre-Authorization Requests: Necessary for obtaining approvals for specified medical services.
- 3. Documentation for Claims: Helps in documenting the need for services in case of claims.
Frequently Asked Questions
How can I edit this PDF?
You can edit this PDF using our PrintFriendly editing tools to adjust text and add information.
What should I include when filling out the form?
Include your personal information, medical records, and ensure everything is typed.
How do I submit the form?
You can submit the form via email, fax, or postal mail as specified in the instructions.
Can I add comments to my PDF?
Yes, our editing tool allows you to add comments or notes directly onto the PDF.
Is it possible to download the edited PDF?
Absolutely! You can download your edited PDF once you finish making changes.
How long does the submission process take?
Please allow 48-72 hours for processing your eligibility requests after submission.
What if my form is not processed?
Ensure all required fields are filled; incomplete submissions may delay processing.
Can I use this for urgent requests?
Yes, make sure to indicate urgency clearly when submitting your form.
What happens if I miss a deadline?
Missing deadlines may result in delays for eligibility verification or service access.
How do I reach customer support?
You can contact our support team via the provided email or phone number for assistance.
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