RMHP Prior Authorization List Effective October 1, 2017 V5 Revised-2026

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  1. Click ‘Get Form’ to open the RMHP Prior Authorization List in the editor.
  2. Begin by filling out the 'Ordering Provider' section. Enter the first name, middle initial, date of birth, gender, and contact information for both the patient and provider.
  3. In the 'Procedure' section, check all applicable CPT codes related to the diagnosis. Ensure you provide any known ICD-10 codes and details about previous surgeries if applicable.
  4. Complete the 'Clinical Information' section by indicating pain levels, previous treatments, and imaging studies completed. Be thorough in documenting any psychosocial or medical issues that may affect surgical outcomes.
  5. Review all entered information for accuracy. Use our platform's features to add comments or additional information as needed before submitting.

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