Step 5-Select Fax Number

TABLE OF CONTENTS

• Select Fax Number
  • Example View
• Not Seeing Your Fax Number?
• Guide me to Step 6-Request & Patient Details

Select Fax Number

• Once you select the "Use this form" button, you will be prompted to the section to select a fax number. 
  • We suggest using the fax number listed on the form to ensure the authorization is faxed to the appropriate location.
• Locate and select the appropriate fax number for your authorization. There are three tab options available: "Recommended Numbers, Favorites" and "Add Fax Number". 

Example View

Not Seeing Your Fax Number?

• "Enter" the desired fax number in the "Add Fax Number" section.
  • Easily locate this number in the future by assigning a "nickname".
• Click "Use This Number" to proceed.

Wrong Fax Number Selected?
Once a fax number has been selected, you can edit the fax number at any time during the creation process. You will then be able to edit the fax number to submit your authorization. 

Guide me to Step 6-Request & Patient Details

We're here to guide you through your prior authorization quest!