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General Information for Authorization. Washington State Health Care Authority presents General Information for Authorization form

General Information for Authorization. Washington State Health Care Authority presents General Information for Authorization form 2025

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The document provides detailed instructions for filling out the General Information for Authorization form (HCA 13-835), which is required for requesting various healthcare services and authorizations. It includes sections for client and provider information, service request details, medical information, and specific codes related to different types of services. The document emphasizes the importance of accuracy in completing all fields and outlines the necessary actions for each section.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the organization number that corresponds to the program/unit for your request in the 'Org' field. Ensure you select the correct code based on the service type.
In the 'Service Type' field, input the appropriate letter(s) in all CAPS that represent the service you are requesting, based on your selection from step 2.
Fill in the 'Client Information' section with the patient's name, client ID, and living arrangements. Make sure to provide accurate details as this information is crucial for processing.
Complete the 'Provider Information' section by entering NPI numbers and fax numbers for both requesting and billing providers.
In 'Service Request Information', describe the service being requested clearly and enter any necessary codes and amounts as specified in each field.
Finally, review all entries for accuracy before submitting your form via fax to ensure a smooth authorization process.

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What information must be on the authorization form?

The authorization form must identify the purpose or need for the information, the extent of the information that may be released, any limits of authorization, date, and signature of patient consent.

What are the 8 requirements of a valid authorization to release information?

Elements: A description of the PHI. The name of the person making the authorization. The name of the person or organization who is authorized to receive the PHI. A description of the purpose for the use or disclosure. An expiration date for the authorization. The signature of the person making the authorization.

What information is required when submitting a pre-authorization request?

After you determine that authorization is needed, you submit a request to the insurance company that includes detailed information about the patient, the proposed procedure or treatment, and the medical necessity for the service. You submit the request through an online portal or by submitting a paper request form.

Which of the following must be included in an authorization?

An authorization document must include all of the following: Description of information to be use or disclose, identification of person authorized to use or disclose information, name of person(s) or group to whom PHI may be given, purpose of use or disclosure, expiration date, valid signature and date.

What information must be included on an authorization to release information?

Begin by specifying your name, the entity authorized to disclose information, and the individuals or entities you authorize to receive it. Indicate the specific information and purpose for which it will be disclosed, add an expiration date or event, and sign and date the form to confirm your consent.

What are the contents of the release of information authorization?

A HIPAA-compliant HIPAA release form must, at the very least, contain the following information: A description of the information that will be used/disclosed. The purpose for which the information will be disclosed. The name of the person or entity to whom the information will be disclosed.

General Information for Authorization. Washington State Health Care Authority presents General Information for Authorization form 2025

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What information must be on the authorization form?

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General Information for Authorization. Washington State Health Care Authority presents General Information for Authorization form 2025

Here's how it works

How to use or fill out General Information for Authorization. Washington State Health Care Authority presents General Information for Authorization form with our platform

See more General Information for Authorization. Washington State Health Care Authority presents General Information for Authorization form versions

Complete this form in 5 minutes or less

Got questions?

What information must be on the authorization form?

What are the 8 requirements of a valid authorization to release information?

What information is required when submitting a pre-authorization request?

Which of the following must be included in an authorization?

What information must be included on an authorization to release information?

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What are the contents of the release of information authorization?

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