PDF
Word
Form F-11066 Prior Authorization / Oxygen Attachment (Pa / OA) - Wisconsin
What Is Form F-11066?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form F-11066?A: Form F-11066 is the Prior Authorization/Oxygen Attachment (Pa/OA) form used in Wisconsin.
Q: What is the purpose of Form F-11066?A: The purpose of Form F-11066 is to request prior authorization for oxygen therapy in Wisconsin.
Q: Who uses Form F-11066?A: Healthcare providers and suppliers use Form F-11066 to request prior authorization for oxygen therapy in Wisconsin.
Q: What information is required on Form F-11066?A: Form F-11066 requires information such as patient's demographic details, medical history, oxygen therapy details, and supporting documentation.
Q: How long does it take to process Form F-11066?A: The processing time for Form F-11066 may vary, but it typically takes around 10 business days.
Q: What happens after submitting Form F-11066?A: After submitting Form F-11066, the healthcare provider will receive a determination letter indicating whether the prior authorization for oxygen therapy has been approved or denied.
Q: Can Form F-11066 be submitted electronically?A: Yes, Form F-11066 can be submitted electronically through the Wisconsin Medicaid Electronic Claims/Billing/Information Partnership (eWiSACWIS) system.
Q: Are there any fees associated with Form F-11066?A: There are no fees associated with submitting Form F-11066.
Q: Is Form F-11066 specific to Wisconsin?A: Yes, Form F-11066 is specific to Wisconsin and is used for requesting prior authorization for oxygen therapy in the state.
Form Details:
- Released on July 1, 2012;
- The latest edition provided by the Wisconsin Department of Health 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 F-11066 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-11066 Prior Authorization / Oxygen Attachment (Pa / OA) - Wisconsin
1
2
