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Treatment authorization request 50 1 form

Tar 50 1 form pdf 2025

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The document is a Treatment Authorization Request Form (TAR) for Partnership HealthPlan of California, used by providers to request authorization for medical services on behalf of patients. It includes sections for patient and provider information, diagnosis, medical justification, and service details. The form also outlines the approval process and notes that authorization does not guarantee payment.

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How to submit a medi-cal tar?

The preferred method of submitting non-drug TARs is the eTAR application. However, mail or hand-delivered TARs with all supporting documentation is also accepted by your local Medi-Cal field office. Drug TARs are submitted electronically using eTAR or NCPDP or fax or mail.

What is a tar report?

Collapse Section. Thrombocytopenia-absent radius (TAR) syndrome is characterized by the absence of a bone called the radius in each forearm and a shortage (deficiency) of blood cells involved in clotting (platelets).

What is a tar in insurance?

Providers can use this form to request authorization for outpatient services, out-of-area authorized referrals and durable medical equipment requests.

Who submits a TAR?

Most Medical and Pharmacy providers use the 50-1 TAR form to request authorization. Long Term Care and Subacute Care providers use the Long Term Care Treatment Authorization Request (20-1) TAR form. Inpatient providers use both the 50-1 and the Request for Extension of Stay in Hospital (18-1) TAR form.