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Silverback care management provider portal 2026

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Click ‘Get Form’ to open the DME Pre-Authorization Request Form in our platform.
Begin by entering today’s date at the top of the form. This helps track your request accurately.
Fill in the Health Plan/Payor section by selecting the appropriate option from the provided list, such as Care N’ Care PPO or Humana Gold Plus.
Enter the patient’s name and birth date in the designated fields to ensure proper identification.
Complete the DME Provider section by providing the DME NPI and contact details for efficient communication.
In the Proposed Date of Service field, specify when you anticipate services will be needed.
Detail any ICD-10 CM Diagnosis Codes and descriptions relevant to this request, ensuring accuracy for processing.
If applicable, describe any special circumstances that should be considered when authorizing services in the comments section.

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