Transcription of Prior Authorization Data Correction Form - Nevada
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Prior Authorization Data Correction Form - Nevada
Nevada Medicaid and Nevada check Up Prior Authorization Data Correction Form Page 1 of 1 FA-29 03/09/2020 (pv05/13/2019)Purpose: Use this form to correct or modify non-clinical, administrative data on a previously submitted Prior Authorization request. This form cannot be used to request re-determination of medical necessity, nor does it take the place of a Prior Authorization request. Please allow up to 30 days for processing. Attachments: Attachments are not required with this form. Documentation to fully support medical necessity must be submitted with the Prior Authorization request and be available in the recipient s medical record.
Nevada Medicaid and Nevada Check Up Prior Authorization Data Correction Form FA-29 Page 1 of 1 03/09/2020 (pv05/13/2019)Purpose: Use this form to correct or modify non-clinical, administrative data on a previously submitted prior authorization request. This form cannot be used to request re-determination of medical necessity, nor does it
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