Outpatient Services Pre-Authorization Form
Outpatient Services Preauthorization Form Please complete ALL information requested on this form. Incomplete forms will be returned to sender. Please fax this form along with all pertinent patient medical records to: Fax to (859) 253-0099 Attn: Pre-Certification Team If the request is urgent, please call (877) 309-2955 option 2. SUBSCRIBER ...
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