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Click ‘Get Form’ to open the seaview ipa authorization form in the editor.
Begin by entering the patient information. Fill in the patient's name, sex, address, date of birth, co-pay amount, city/state, member ID number, phone number, health plan name, plan code, and zip code.
Next, specify the primary care physician (PCP) and indicate if there is other insurance coverage. If yes, provide the name and fax number of the other insurance provider.
In the 'Prior Authorization Request' section, enter the ICD-9 and CPT codes relevant to the services requested. Provide a detailed description of the procedure or service along with frequency/duration requested.
Complete the treatment plan and specify the hospital or facility where services will be provided. Include expected date of admission and details about any assistant surgeon if applicable.
Finally, have the physician print their name, sign, and date at the bottom of the form. Ensure all sections are filled accurately before submission.
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Need help? Contact our support team at (987) 654-3210 for questions, inquiries, and more information about ChoiceOne IPA.
What is the phone number for Seaview IPA authorization?
You may reach one of our caring, knowledgeable representatives by calling (805) 988-5188 Monday thru Thursday from 8:00 a.m. to 5:00 p.m., and Fridays from 9:00 a.m. until 5:00 p.m. Our representatives are all local and familiar with our network physicians as well as with the community.
What is the phone number for SeaView Insurance?
This Privacy Policy describes the policies of Seaview Insurance Company, 1000 Aviara Parkway #300, Carlsbad, CA 92011, United States of America (the), email: privacy@svinsco.com, phone: (877) 365-1648 on the collection, use and disclosure of your information that we collect when you use our website ( svinsco.com ).
What is the phone number for SeaView IPA provider claims?
Providers are not required to submit disputes in writing and may, alternatively, telephone SeaView at (805) 604-3325 with inquiries or concerns; in which case SeaView will respond to the inquiry or concern by following SeaViews standard customer service procedures, in lieu of the Provider Dispute Resolution Process
What is the phone number for smart health prior authorization?
Questions regarding enrollment or procedures that require prior authorization should be directed to the SmartHealth Customer Service Department at (888) 492-6811. (Hours of operation are 8:30am-4:30pm EST) Monday-Friday, excluding holidays.
Although the agreement form does not ask for the Deans signature, we assume we should not submit that form as final until the dean gives final approval,.
County of Ventura Retiree Health Benefits Handbook Plan
Please note that some services require pre-authorization, an example of this is a PET scan. Please refer to your plan document or contact the plan directly
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