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This version of the form is not currently in use and is provided for reference only. Download this version of
Form 470-5619
for the current year.
Form 470-5619 Medicaid Supplemental Information Prior Authorization Form - Iowa
What Is Form 470-5619?
This is a legal form that was released by the Iowa Department of Human Services - a government authority operating within Iowa. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 470-5619?
A: Form 470-5619 is the Medicaid Supplemental Information Prior Authorization Form specific to Iowa.
Q: What is the purpose of Form 470-5619?
A: The purpose of Form 470-5619 is to request prior authorization for Medicaid supplemental information in Iowa.
Q: Who needs to fill out Form 470-5619?
A: Healthcare providers or authorized representatives need to fill out Form 470-5619 in order to request prior authorization for Medicaid supplemental information in Iowa.
Q: Is Form 470-5619 specific to Iowa?
A: Yes, Form 470-5619 is specific to Iowa as it is the Medicaid Supplemental Information Prior Authorization Form used in the state.
Form Details:
- Released on June 1, 2020;
- The latest edition provided by the Iowa Department of Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 470-5619 by clicking the link below or browse more documents and templates provided by the Iowa Department of Human Services.
