Healthfirst outpatient authorization form 2025

See details

4.4 out of 5

205 votes

The document is a Prior Authorization Request Form for Apple Health/Medicaid and Medicare Advantage Plans, detailing the submission process via the Care Management Portal or fax. It includes contact information for customer service, instructions for completing the form, and emphasizes the need for supporting clinical documentation. The form collects information about the ordering provider, patient details, services requested, and clinical urgency.

Here's how it works

01. Edit your 8443472955 online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send 844 347 2955 via email, link, or fax. You can also download it, export it or print it out.

How to modify Healthfirst outpatient authorization form in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Adjusting paperwork with our feature-rich and user-friendly PDF editor is simple. Adhere to the instructions below to complete Healthfirst outpatient authorization form online quickly and easily:

Sign in to your account. Sign up with your email and password or register a free account to test the product prior to upgrading the subscription.
Upload a document. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit Healthfirst outpatient authorization form. Quickly add and underline text, insert pictures, checkmarks, and icons, drop new fillable areas, and rearrange or remove pages from your document.
Get the Healthfirst outpatient authorization form completed. Download your updated document, export it to the cloud, print it from the editor, or share it with other people via a Shareable link or as an email attachment.

Take advantage of DocHub, one of the most easy-to-use editors to rapidly handle your paperwork online!

See more healthfirst outpatient authorization form versions

We've got more versions of the healthfirst outpatient authorization form form. Select the right healthfirst outpatient authorization form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (85 Votes)
2020	4.4 Satisfied (205 Votes)
2013	4 Satisfied (30 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the fax number for Healthfirst authorization?

If you are a non-participating provider or encounter issues submitting via the online provider portal, please fax your authorization request to 1-855-328-0059 (toll-free) or 321-434-4271 (local). For additional assistance you may also call Customer Service toll-free at 1-844-522-5278.

What is a prior authorization request form?

Prior authorization (prior auth, or PA) is a management process used by insurance companies to determine if a prescribed product or service will be covered. This means if the product or service will be paid for in full or in part.

What is the phone number for Evicore Healthfirst?

For program-related questions or concerns, please email clientservices@evicore.com or call our toll-free number: 1-877-773-6964. 28. Where can I find additional information? For more information and reference documents, please visit our implementation site: .evicore.com/healthplan/healthfirst.

What is the phone number for Healthfirst provider authorization?

If you have any questions, please call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am5:30pm.

What is the phone number for Healthfirst pharmacy prior authorization?

Our Healthfirst pharmacy team is here to help. Call 1-844-347-2955.

healthfirst prior authorization

Healthfirst outpatient authorization form pdf Healthfirst prior authorization form pdf Healthfirst outpatient authorization form online Healthfirst prior authorization form for medication Healthfirst forms Healthfirst prior authorization phone number Healthfirst Medicaid Prior Authorization Form CVS Caremark healthfirst Prior Authorization Form

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

What is a medical authorization form?

Healthfirst at a Glance - CompleteCare (HMO D-SNP) A Medicaid Advantage Plus plan that combines Medicare and Medicaid benefits with long-term care services.

Is Healthfirst an insurance provider?

Healthfirst is an insurance company that offers Medicare Advantage plans in specific areas of New York state. Healthfirst has been in operation for more than 25 years. It offers various healthcare plans, including Medicare Advantage and Medicaid plans, as well as individual and group plans.

Healthfirst outpatient authorization form 2025

Here's how it works

How to modify Healthfirst outpatient authorization form in PDF format online

See more healthfirst outpatient authorization form versions

Complete this form in 5 minutes or less

Got questions?

What is the fax number for Healthfirst authorization?

What is a prior authorization request form?

What is the phone number for Evicore Healthfirst?

What is the phone number for Healthfirst provider authorization?

What is the phone number for Healthfirst pharmacy prior authorization?

Complete this form in 5 minutes or less

People also ask

What is a medical authorization form?

Is Healthfirst an insurance provider?

healthfirst authorization form

Try more PDF tools