20182022 Form CareFirst BCBS CUT01241E Fill Online, Printable
Carefirst Community Health Plan Prior Authorization Form. Contact name and phone number: Department of health and human services 200 independence avenue, sw room 509f, hhh building washington, d.c.
Web prior authorization requests must be submitted electronically through the carefirst provider portal for all drugs requiring prior authorization. Web procedures requiring prior authorization. Web provider information submitting provider name: Web prior authorization requirements 2022 prior authorization (pa): Contact name and phone number: Only the 1st five numbers, no alpha digits/modifiers. Department of health and human services 200 independence avenue, sw room 509f, hhh building washington, d.c. _ services provided by or facility/provider id# contact name and phone. Web fax completed form with supporting medical documentation to: Web prior authorization request form carefirst bluecross blueshield community health plan district of columbia 1100 new jersey ave se suite 840 washington, d.c.
Web provider information submitting provider name: Web preauthorization request form fax completed form with supporting medical documentation to: Web procedures requiring prior authorization. If you are already using the. Web fax completed form with supporting medical documentation to: Department of health and human services 200 independence avenue, sw room 509f, hhh building washington, d.c. Members who need prior authorization should work with their provider to submit the required. Web or, you may click here to download a clinical prior authorization criteria request form to request medication specific clinical criteria. Web medical forms are organized by the plan you have and how you purchased your plan: Web provider information submitting provider name: You have an affordable care act (aca) plan if you bought your plan directly through.
