Ma 97 form 2025

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The document is a guideline for completing the Outpatient Services Authorization Request form (MA 97) for the Commonwealth of Pennsylvania's Department of Public Welfare. It provides detailed instructions on how to fill out the form, including sections for patient and provider information, diagnosis codes, requested services, and necessary attachments. The form is used to request prior authorization or 1150 Waiver services for outpatient medical assistance programs.

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