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Sponsor SSN / DOD Benefits Number Patient Name Last First MI / Patient Date of Birth Patient Address ZIP Code Street Patient Home Phone City State Other Health Insurance Servicing Provider Information Complete all applicable fields. Specialty Phone Address Facility Name If Applicable Requested Service Information Complete as many sections as required* Diagnosis Description Code Service 1 CPT/HCPC/NDC Code Number of Visits If DME Purchase IF DME Frequency If global maternity due date Duration R ...

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Who sends the prior authorization form?

Under prior authorization, the provider or supplier submits the prior authorization request and receives the decision before services are rendered.

Does Texas Medicaid require prior authorization?

Except for emergency services, post-stabilization services, and services provided to you during an approved inpatient admission, all services from an out-of-network provider must be prior authorized. Claims for services from out-of-network providers that are not approved before the service is given may be denied.

What is an example of prior authorization?

For example, your health plan may require prior authorization for an MRI, so that they can make sure that a lower-cost x-ray wouldnt be sufficient. The service isnt being duplicated: This is a concern when multiple specialists are involved in your care.

What is the prior authorization number?

A number, code, or other value that indicates the services provided on this claim have been authorized by the payee or other service organization, or that a referral for services has been approved.

What does getting a prior authorization mean?

Prior authorizationsometimes called precertification or prior approvalis a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

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What is the fax number for BCBS of Texas prior authorization form?

Have your doctor fax in completed forms at 1-877-243-6930.

What does prior authorization mean in healthcare?

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

What is the fax number for the Texas Standard Prior Authorization Request form?

If you think more information or an additional form may be needed, please check the issuers website before faxing or mailing your request. Please fax form to Superior HealthPlan at 1-866-399-0929.

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What is the fax number for BCBS of Texas prior authorization form?

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