Private Duty Nursing / Extended Home Health Aide Prior Authorization Request Form - South Dakota

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Private Duty Nursing / Extended Home Health Aide Prior Authorization Request Form - South Dakota

Private Duty Nursing/Extended Home Health Aide Prior Authorization Request Form is a legal document that was released by the South Dakota Department of Social Services - a government authority operating within South Dakota.

FAQ

Q: What is the Private Duty Nursing/Extended Home Health Aide Prior Authorization Request Form?
A: The Private Duty Nursing/Extended Home Health Aide Prior Authorization Request Form is a document used in South Dakota to request approval for private duty nursing or extended home health aide services.

Q: Who can use the Private Duty Nursing/Extended Home Health Aide Prior Authorization Request Form?
A: The form can be used by healthcare providers and individuals who need private duty nursing or extended home health aide services in South Dakota.

Q: What is the purpose of the form?
A: The form is used to request prior authorization from the South Dakota Medicaid program for private duty nursing or extended home health aide services.

Q: What information is required on the form?
A: The form requires information such as the patient's demographics, medical condition, physician's order, and the requested services.

Q: Are there any fees for submitting the form?
A: There are no fees for submitting the form to request prior authorization for private duty nursing or extended home health aide services in South Dakota.

Q: How long does the approval process take?
A: The approval process for private duty nursing or extended home health aide services can take up to 60 days.

Q: What should I do if my request is denied?
A: If your request for prior authorization is denied, you can appeal the decision by following the instructions provided by the South Dakota Medicaid program.

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Form Details:

  • Released on February 1, 2018;
  • The latest edition currently provided by the South Dakota Department of Social Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the South Dakota Department of Social Services.

Download Private Duty Nursing / Extended Home Health Aide Prior Authorization Request Form - South Dakota

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