Florida prior authorization form 2026

1. Click ‘Get Form’ to open the Florida Prior Authorization Form in the editor.
2. Begin by entering the member's Date of Birth and Member ID/Medicaid ID in the designated fields. Ensure all required fields marked with an asterisk (*) are filled out accurately.
3. In the Requesting Provider Information section, input the Requesting NPI, TIN, Provider Contact Name, and Phone/Fax details. This information is crucial for processing your request.
4. If applicable, provide Servicing Provider/Facility Information. You can select 'Same as Requesting Provider' if they are identical; otherwise, fill in the Servicing NPI and TIN along with the Facility Name.
5. Complete the Authorization Request section by entering ICD-10 codes, Primary Procedure Code, Start Date or Admission Date, and any Additional Procedure Codes as necessary.
6. Select the Inpatient Service Type from the provided options. Make sure to check that all required fields are completed to avoid rejection of your form.
7. Finally, review your entries for accuracy and completeness before submitting. Remember to attach any supporting clinical information as it may be required for processing.

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