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Msa 0732-2026
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- Click ‘Get Form’ to open the MSA-0732 in the editor.
- Begin by entering the Prior Authorization Number, which is for MDHHS use only.
- Indicate whether this request is an initial or renewal request. If it's a renewal, specify if you are increasing or decreasing units.
- Fill in the PDN provider information, including agency name, NPI number, and contact details.
- Provide beneficiary information such as name, birth date, sex, and mihealth card number.
- If applicable, include other insurance details and hospital information if the beneficiary is currently hospitalized.
- Complete the ordering physician's information and describe the services to be provided using HCPCS codes.
- Finally, ensure all signatures are obtained from both the provider and parent/guardian before submission.
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