Example: bachelor of science
Section Ii Review Expedited Urgent
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Texas Standard Prior Authorization Request Form for …
www.bcbstx.comYou may also request an urgent review to authorize treatment of an acute injury or illness, if the provider determines that the condition is severe or painf ul enough to warrant an expedited or urgent review to prevent a serious deterioration of the patient’s condition or health. Section IV – Provider Information:
Texas Standard Prior Authorization Request Form for ...
www.tdi.texas.govSection I – Submission: ... II — R EVIEW Expedited/Urgent Review Requested: By checking this box and signing below, I certify that applying the standard review time frame may seriously jeopardize the life or health of the patient or the patient’s ability to regain maximum function.