Form FA-95 Hospice Prior Authorization Request - Nevada

What Is Form FA-95?

This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form FA-95?A: Form FA-95 is the Hospice Prior Authorization Request form in Nevada.

Q: What is the purpose of Form FA-95?A: The purpose of Form FA-95 is to request prior authorization for hospice services in Nevada.

Q: Who can use Form FA-95?A: Form FA-95 can be used by healthcare providers, hospice agencies, or patients themselves to request prior authorization for hospice services in Nevada.

Q: How do I fill out Form FA-95?A: You need to provide information such as patient demographics, diagnoses, treatment plan, and physician certification in order to fill out Form FA-95.

Q: Is there a fee for submitting Form FA-95?A: No, there is no fee for submitting Form FA-95.

Q: Is Form FA-95 mandatory for hospice services in Nevada?A: Yes, Form FA-95 is mandatory for requesting prior authorization for hospice services in Nevada.

Q: How long does it take to get a response to Form FA-95?A: The response time for Form FA-95 can vary, but it typically takes around 7-10 business days to receive a determination from the Nevada Medicaid program.

Q: What should I do if my Form FA-95 is denied?A: If your Form FA-95 is denied, you have the right to appeal the decision. You can contact the Nevada Medicaid program for more information on the appeals process.

Q: Are there any specific requirements for Form FA-95?A: Yes, there are specific requirements for Form FA-95, such as the need for physician certification and supporting documentation. It is important to review the instructions and guidelines provided with the form.

Q: Can I fax or mail the completed Form FA-95?A: Yes, you can fax or mail the completed Form FA-95 to the Nevada Medicaid program. The contact information for submission is provided on the form.

Q: Can I track the status of my Form FA-95?A: Yes, you can track the status of your Form FA-95 submission through the Nevada Medicaid Provider Web Portal.

Q: What other documentation should I include with Form FA-95?A: You should include supporting documentation such as medical records, physician orders, and any other relevant information to support the request for hospice services.

Q: Are there any time limitations for submitting Form FA-95?A: Yes, there are time limitations for submitting Form FA-95. It is important to submit the form as soon as possible to ensure timely authorization of hospice services.