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Payer Information
Fax Forms and Resources
Fax Forms
Part 2 Authorization Request Form (Humana only)
Part 2 Authorization Request Form (Humana only)
Diagnostic imaging
Fax form: Diagnostic imaging
Part 1 Fax Form (Diagnostic imaging)
Facility based sleep studies
Part 1 Fax Form (Facility-based sleep studies)
Fax form: Facility-based sleep studies
Cardiovascular
Fax Form: Cardiac Ablation
Fax Form: Cardiac Catheterization, Other
Fax Form: Cardiac Computerized Tomography Angiography
Fax Form: Cardiac Implanted Device (Defibrillator)
Fax Form: Cardiac Implanted Device (Pacemaker)
See all 34 articles
Musculoskeletal
Fax Form: Epidural Steroid Injections, Outpatient
Fax Form: Facet Injection / Medial Branch Block (MBB)
Fax Form: Foot Surgeries, Bunionectomy and Hammertoe
Fax Form: Hip Arthroplasty
Fax Form: Hip Arthroscopy
See all 21 articles
Surgical Services
Part I Fax Form (Surgical Services)