Bcn authorization forms 2025

Get Form
bcn prior authorization form Preview on Page 1

Here's how it works

01. Edit your bcn prior authorization form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send 888 989 0057 via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out bcn authorization forms with our platform

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open the bcn authorization form in the editor.
  2. Begin by entering today’s date and selecting whether this is a precertification or recertification request.
  3. Fill in the MEMBER and LTACH INFORMATION section, including the member's name, contract number, date of birth, and current phone number. Provide details about the member's living situation and support system.
  4. Complete the CLINICAL INFORMATION section by entering vital statistics such as height, weight, and any relevant medical history. Ensure to include medication lists and treatment details.
  5. In the REHABILITATION THERAPY section, document any therapy needs for physical, occupational, or speech therapy.
  6. Finally, review all sections for accuracy before submitting your completed form through our platform.

Start using our platform today to streamline your bcn authorization form completion for free!

See more bcn authorization forms versions

We've got more versions of the bcn authorization forms form. Select the right bcn authorization forms version from the list and start editing it straight away!
Versions Form popularity Fillable & printable
2013 4.8 Satisfied (230 Votes)
be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Phone: (800) 541-6652 7 a.m. to 5 p.m. PT, Monday through Friday, 8 a.m. to 5 p.m. PT, Saturday and Sunday.
Submit a global referral to contracted specialists? (BCN only) Click on the Referrals/Authorizations link at the top of the home page and choose Submit Global Referral. Enter all information identified by the asterisk (*). Click Submit. Submit a global referral to contracted specialists?
If you have questions, please contact Provider Inquiry from 8:30 a.m. to noon or 1 to 5 p.m., Monday through Friday: Professional: 1-800-344-8525. Facility: 1-800-249-5103.