Preauthorization Request for Medical Services (for State Fund Worker's Comp Patients)
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
 Preauthorization Request for Medical Services (for State Fund Worker's Comp Patients) (101KB DOC)
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| Description | This form can only be used for services that can be authorized by the claim manager and it should not be used for Utilization Review (Qualis), Provider Hotline or requests to the Occupational Nurse Consultant. If you are unsure of what services need to be authorized see L&I fee lookup utility. |
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| Detail | ||
| Form number | F242-397-000 | |
| Availability | Online only. See document above to download. |
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| Keywords | authorization, authorization, preauthorization, preauthorization | |
| Languages | English | |
| Valid dates | 02-2013 | |
| Contact information |
Managing Injured Workers' Claims
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| Web pages | To find out what services must be authorized | |
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