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C 4 auth formDocHubcom 2014

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The document outlines the process for requesting authorization for special medical services related to workers' compensation cases in New York. It includes sections for patient and provider information, details on the requested services, and the insurance carrier's response. The form emphasizes the attending physician's responsibility to demonstrate medical necessity and provides guidelines for handling denials and response timelines.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (91 Votes)
2018	4.4 Satisfied (269 Votes)
2014	4.4 Satisfied (588 Votes)
2013	4.4 Satisfied (239 Votes)

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