Prior Authorization Request (Outpatient), Continued Step At least one 7.2 diagnosis code must be attached to the case. If there are more than one, one must be selected as the primary. If you want to add a second code, delete the original entry and enter the new code or description. Step Enter any clinical 8 notes in the text field. clinical Step Attach documentation by 9 clicking the browse button. Continued on next page Prior Authorization Request (Outpatient), Continued Step Browse and find 9.1 the file and click Open to attach. Once attached, click Attach File. Step File name will 9.2 appear when it is successfully uploaded. Step The indicator icons 10 on the left of the screen should be visible in all service request areas to show that all required data has been inputted. Continued on next page
Prior Authorization Request (Outpatient), Continued Step 7.2 At least one diagnosis code must be attached to the case. If there are more than one, one must be selected as the primary. If you want to add a second code, delete the original entry and enter the new code or description. Step 8 Enter any clinical notes in the text field. Step 9 Attach clinical documentation by clicking the browse button. Continued on next page Prior Authorization Request (Outpatient), Continued Step 9.1 Browse and find the file and click Open to attach. Once attached, click Attach File. Step 9.2 File name will appear when it is successfully uploaded. Step 10 The indicator icons on the left of the screen should be visible in all service request areas to show that all required data has been inputted. Continued on next page