Step 7-Provider & Location Details

TABLE OF CONTENTS

• Requester Details
  •  Example View
• Provider Details
  • Example View
• Location Details
  • Example View
• Select "Next"
• Guide me to Step 8-Form Details

Requester Details

• Your name and phone number will populate here. This can be edited if a change is required. 

 Example View

Provider Details

• Provider details will be entered in one of two ways:
  • Entered manually.
  • Pre-populated and selected.

If the provider you are looking for does not populate, the provider will need to be entered manually. 

To enter and save a provider for future use, simply click the " + Add Provider " option at the bottom of the provider list and enter the provider NPI number.

If your referring provider is different from your servicing provider, utilize the tab "Referring Provider" to add this information here. 

Saved Provider Details Incorrect?
See steps on how to edit an existing provider here. **Please note that only a user with administrative capabilities can edit provider information. 

Example View

Location Details

• Location details will be entered in one of two ways:
  • Entered manually.
  • Pre-populated and selected.
• Location Name:
  • You will need to enter a location name, which will appear on all authorization requests.
• Location Nickname:
  •  Additionally, you have the option to include a location nickname, which can help you easily identify the appropriate servicing location. 
    • We recommend using the city name for a specific office or the street name if the offices are located within the same city.
    •  

If the location you are looking for does not populate, the location will need to be entered manually.

To enter and save a location for future use, simply click " + Add Location" option at the bottom of the location list and enter the location NPI number.

Saved Location Details Incorrect?
See steps on how to edit an existing location here. **Please note that only a user with administrative capabilities can edit provider information. 

Example View

Select "Next"

• Select "Next" to move to the next step in the process!

Guide me to Step 8-Form Details

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