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All Prior Authorization requests must either be faxed on this template or be submitted through the W

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The document is a template for submitting prior authorization requests for physical and occupational therapy. It outlines the necessary information required, including claimant details, provider information, procedure codes, treatment plans, and supporting medical documentation. Incomplete requests will be returned, and it emphasizes the need to include a prescription from the attending physician.

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

Can I submit a prior authorization myself?

The patient or their representative can contact their insurance company and provide the relevant information to start the Prior Authorization process. Its best to confirm with the healthcare provider if they have the information and are willing to submit the request.

Who is responsible for requesting prior authorization?

The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patients insurance provider.

Who handles submitting a request for a prior authorization for care?

If you dont get permission from your health plan, your health insurance wont pay for the service. Youll be stuck paying the bill yourself.

What happens if you dont get prior authorization?

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 items are needed to submit a prior authorization request?

to the insurer: Patient name, date of birth, insurance policy number, and other relevant information. Physician and facility information (eg, name, provider ID number, and tax ID number) Relevant procedure and HCPCS codes for products/services to be provided/performed.

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Who deals with prior authorization?

Your health care provider can make the prior authorization request. If your provider submits the request, they will send the required information to your health plan. You may need to fill out forms for your providers office.

Can a doctors office charge for prior authorization?

If you need prior authorization, your doctors office will process the request for you at no charge. They will follow up with your insurance company until the request is approved or denied. This process can involve a great deal of back and forth.

Get the up-to-date All Prior Authorization requests must either be faxed on this template or be submitted through the W 2025 now

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The easiest way to modify All Prior Authorization requests must either be faxed on this template or be submitted through the W in PDF format online

Complete this form in 5 minutes or less

Got questions?

Can I submit a prior authorization myself?

Who is responsible for requesting prior authorization?

Who handles submitting a request for a prior authorization for care?

What happens if you dont get prior authorization?

What items are needed to submit a prior authorization request?

Complete this form in 5 minutes or less

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Who deals with prior authorization?

Can a doctors office charge for prior authorization?

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