047 Preauthorization Request Form for Surgical Management of Obesity 2026

1. Click ‘Get Form’ to open the 047 Preauthorization Request Form in our editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's name, today's date, BCBSMA ID#, date of surgery, date of birth, height/weight, blood pressure, and current BMI.
3. Next, complete the 'Physician Information' section by providing the physician's name and facility details including address and contact numbers.
4. In the 'Procedure Information' section, select the appropriate diagnosis code that corresponds to the patient's condition. Ensure you check all relevant boxes.
5. Indicate any co-morbid conditions in the designated area and confirm that the patient meets selection criteria by checking applicable boxes.
6. Finally, review all entered information for accuracy before saving or exporting your completed form directly from our platform.

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