Excellus Outpatient Authorization Form Instructions
This file contains important instructions and guidelines for completing the Excellus Outpatient Authorization Form. It provides detailed information on how to fill out the form correctly to avoid processing delays. Follow the instructions carefully to ensure a smooth authorization request process.
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How do I fill this out?
To successfully complete this form, begin by gathering all necessary member and provider information. Carefully read the instructions to understand each field requirement. Finally, ensure you review the completed form for accuracy before submission.
How to fill out the Excellus Outpatient Authorization Form Instructions?
1
Print a new form from the website.
2
Fill in required fields clearly, preferably in typed format.
3
Upload necessary clinical documentation with your submission.
4
Mark the request as Urgent or Standard clearly.
5
Review the form for completeness before submitting.
Who needs the Excellus Outpatient Authorization Form Instructions?
1
Healthcare providers submitting authorization requests for patients.
2
Patients seeking treatment that requires prior authorization.
3
Office staff managing patient prescriptions and treatments.
4
Billing departments requiring pre-approval for services.
5
Insurance agents helping clients navigate the authorization process.
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1
Open the PDF using the PrintFriendly editor.
2
Fill out all required fields with accurate information.
3
Use annotation tools to add notes or comments as needed.
4
Save your changes directly within the editor.
5
Download the edited PDF for submission.
What are the instructions for submitting this form?
To submit the authorization form, you can either fax it to the designated number, upload it through our SDS portal, or send it via physical mail to the specified address. Ensure that all required fields are completed to avoid rejection. It's advised to call customer service if you need assistance or clarification during the submission process.
What are the important dates for this form in 2024 and 2025?
Important dates for submitting authorization requests include the standard submission deadlines for services beginning in 2024 and 2025. Keep in mind that changes in policy may occur, impacting these timelines. Always check for the latest updates on our website.
What is the purpose of this form?
The purpose of this form is to request prior authorization for outpatient services covered by the Excellus Health Plan. It ensures that the treatment is deemed medically necessary and compliant with the plan's coverage criteria. Properly completing this form facilitates timely processing and reduces the likelihood of delays or denials.
Tell me about this form and its components and fields line-by-line.
- 1. Member Information: Includes fields for Medicaid/Member ID and personal details such as Last Name, First Name, and Date of Birth.
- 2. Requesting Provider Information: Collects information including Requesting NPI, TIN, and Provider Contact details.
- 3. Servicing Provider/Facility Information: Details necessary for the servicing provider, including NPI, TIN, and fax number.
- 4. Authorization Request: Contains crucial codes, dates, and Insurance type details for the service being requested.
- 5. Outpatient Service Type: Categorizes the type of service being requested, with a list of relevant codes.
What happens if I fail to submit this form?
Failure to submit this form correctly may result in processing delays or denial of your request. It's crucial to ensure all fields are correctly filled to avoid complications.
- Incomplete Forms: If required fields are missing, the form will be rejected, leading to a delay in authorization.
- Incorrect Information: Providing inaccurate details can cause confusion and complications in processing.
- Failure to Upload Documentation: Missing clinical documentation may delay the decision process significantly.
How do I know when to use this form?
- 1. Before Medical Treatments: When scheduling outpatient services, this form must be completed.
- 2. For New Procedures: Any new treatment requiring pre-approval should utilize this form.
- 3. For Increased Service Units: Request authorization for additional therapy sessions or consultations.
Frequently Asked Questions
How do I access the Excellus Outpatient Authorization Form?
You can access the form directly from our website by navigating to the authorization section.
Can I save the filled form for later use?
You can download your filled form immediately after editing, but the site does not support saving files.
What if I forget to fill out a required field?
If any required field is left blank, your submission may be delayed or rejected.
Is there a specific format for submitting the authorization form?
Please ensure that all digital submissions are typed and that handwritten notes are in black ink.
What types of services require this form?
Services such as outpatient procedures and therapies often require this authorization.
How long does it take to process my authorization request?
Processing times can vary, but requests made after 5 p.m. will be handled the next business day.
What should I do if my request is urgent?
Clearly mark your request as urgent on the form to ensure prompt processing.
Can I submit multiple requests at once?
To expedite processing, please submit one request per form.
Who should I contact if I have questions about my submission?
Feel free to call our customer service for assistance with any inquiries regarding your submission.
What happens if I don’t receive a determination on time?
Contact us if you have not received a determination within the expected timeframe to avoid duplicate submissions.
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