Transcription of SURGERY PRECERTIFICATION REQUEST FOR NJ PIP …
{{id}} {{{paragraph}}}
Example: dental hygienist
SURGERY PRECERTIFICATION REQUEST FOR NJ PIP …
Optum Managed Care Services (Optum) 2500 Monroe Boulevard, Suite 100 Norristown, PA 19403 (610) 631-7011 (AIMS Dedicated Fax) (800) 275-9485 (toll free) E-mail: SURGERY PRECERTIFICATION REQUEST FOR NJ PIP CLAIMS (This does not apply to EMERGENCY PROCEDURES) Optum Managed Care Services 2500 Monroe Boulevard, Suite 100 Norristown, PA 19403 Fax: (610) 631-7011 REQUEST Date: _____ Patient Name: _____ Physician Name: _____ Claim No.: _____ Telephone No.: _____ Date of Loss: _____ Fax No.: _____ TIN: _____ Please complete below: Include documentation to support the need for and causal relationship of SURGERY ( , MRIs, CT scans, Discogram, EMG and most recent office notes).
Optum Managed Care Services (Optum) 2500 Monroe Boulevard, Suite 100 Norristown, PA 19403 (610) 631-7011 (AIMS Dedicated Fax) (800) 275-9485 (toll free)
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: