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Get Nv Silver Summit Healthplan Nv-paf-119 2017-2026
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How to fill out the NV Silver Summit Healthplan NV-PAF-119 online
Filling out the NV Silver Summit Healthplan NV-PAF-119 form is an essential step in ensuring that you receive necessary outpatient services. This guide will provide you with clear, step-by-step instructions to assist you in completing the form correctly online.
Follow the steps to effectively complete the NV Silver Summit Healthplan NV-PAF-119 form online.
- Click ‘Get Form’ button to obtain the form and open it in your digital workspace.
- Begin by entering the member information in the designated fields. You will need to provide the Medicaid/Member ID, date of birth (MMDDYYYY), and the last name, followed by the first name of the member.
- Next, move to the requesting provider information section. Fill in the requesting NPI and TIN, along with the requesting provider's name, contact name, phone number, and fax number.
- If the servicing provider is the same as the requesting provider, select that option; otherwise, fill in the servicing provider's information by providing their NPI and TIN, as well as the name, contact name, phone number, and fax number.
- In the authorization request section, enter the primary procedure code and any additional procedure codes, including relevant modifiers as needed. Make sure to accurately fill in the outpatient service type based on the given options.
- Provide the start date or admission date, as well as the diagnosis code (ICD-10). If applicable, also include the end date or discharge date.
- Indicate the total units, visits, or days required for the service. Ensure all required fields are completed, as incomplete forms will not be accepted.
- Lastly, gather and include all supporting clinical information. Remember that lacking this information may lead to delayed determinations.
- Review the entire form for accuracy and completeness. Once satisfied, you may save changes, download, or print the form for submission.
Complete your NV Silver Summit Healthplan NV-PAF-119 form online to ensure timely processing.
The Nevada health plan refers to the variety of coverage options available to residents, including private insurance and Medicaid services. Specifically, the NV Silver Summit Healthplan NV-PAF-119 provides tailored healthcare plans that cater to the needs of Nevadans. It's vital for residents to explore their health options to maximize available resources.
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