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Click ‘Get Form’ to open the fl prior authorization in the editor.
Begin by filling in the MEMBER INFORMATION section. Enter the Medicaid/Member ID, Date of Birth (MMDDYYYY), and the member's Last Name and First Name. Ensure all required fields are completed.
Next, move to the REQUESTING PROVIDER INFORMATION. Input your Requesting NPI, TIN, Provider Name, Contact Name, Phone, and Fax. All fields marked with an asterisk (*) are mandatory.
In the SERVICING PROVIDER / FACILITY INFORMATION section, if applicable, check 'Same as Requesting Provider' or fill in the Servicing NPI and TIN along with other details.
Proceed to AUTHORIZATION REQUEST. Fill in the Primary Procedure Code and any Additional Procedure Codes as necessary. Specify the OUTPATIENT SERVICE type by entering its corresponding number.
Complete the dates for Start/Admission and End/Discharge along with Diagnosis Code (ICD-10) and Total Units/Visits/Days.
Review all entries for accuracy before submitting. Remember that incomplete forms will be rejected.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (120 Votes)
2016	4.4 Satisfied (137 Votes)

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What is the phone number for BCBS of Florida prior authorization?

Drugs That May Require Prior Authorization Drug ClassDrugs in Class Epidiolex Epidiolex Erythroid Stimulants , , Procrit and Retacrit, Mircera Esbriet Esbriet Evenity Evenity243 more rows

Can I call my insurance about a prior authorization?

You can call your insurance company and ask about pre authorization and when they say yes its needed, ask them to call your dr on your behalf because your dr is not being helpful with getting the ball rolling on the pre auth.

What is the phone number for BCBS Florida customer service?

A prior authorization number is a unique identifier assigned by an insurance company as approval of coverage for a specific medical service, procedure, or prescription drug.

sunshine prior authorization form

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