Prior Approval (PA)
Below is a list of all the Prior Approval forms available for submission using the Inbound Documents API.
|
Form / Document |
Description |
| ACC18 Add diagnosis from sport physicians | ACC18 # with description |
| CSARTP | CSARTP from provider, e.g. Ben Speedy, AXIS, etc. |
| Email from Provider | Email received from (provider) re: |
| High Technology Artifical Limb | High Technology Artifical Limb |
| Hi-Tech imaging prior approval request | MRI, CT scan, NaF scan, DEXA scan, CST13 |
| HTI / High Tech Imaging reports | Radiology Report |
| Invoice for Medical report/record | If no purchase order number, email or send to person who requested notes |
| IPM - Interventional Pain Management | IPM report received from Dr Wallbridge |
| M41 / ACC41 | ACC41 Referral for Treatment |
| Medical records/ notes | Medical notes |
| Miscellaneous documents | VCF012 - Miscellaneous document - Miscellaneous |
| Nerve Conduction Studies | VCF024 Nerve conduction studies results |
| Pain Physician Assessment | Pain Physician Assessment |
| Pharmacy invoice queries | Pharmacy invoice queries |
| Prescription invoices | Prescription invoices |
| Referral/Request for Nerve Conduction Studies (NCS) Medical Case Review (CSM1) Fexible Cystoscopy CST13 | Request for Nerve Conduction Study/Medical Case Review/Flexible Cystoscopy |
| Request for Nafscan/Bone scan - from Radiology | Nafscan request |
| Request for consult/assessment | Neurology Assessment/Rheumatology Assessment |
| Request for other injection type, e.g. CSP2 | CSP2, Transforaminal injection |
| Request for Steroid Injection (with referral) | USGI (U27), S85, CTGI (T80), Fluroscopic (S79) |