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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 FA-16A
for the current year.
Form FA-16A Intermittent Services Prior Authorization Request - Home Health Agency - Nevada
What Is Form FA-16A?
This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form FA-16A?
A: Form FA-16A is the Intermittent Services Prior Authorization Request for Home Health Agency in Nevada.
Q: What is the purpose of Form FA-16A?
A: The purpose of Form FA-16A is to request prior authorization for intermittent services from a home health agency.
Q: Who should use Form FA-16A?
A: Home health agencies in Nevada should use Form FA-16A to request prior authorization for intermittent services.
Q: What type of services are covered by Form FA-16A?
A: Form FA-16A covers intermittent services provided by home health agencies.
Form Details:
- Released on January 29, 2018;
- The latest edition provided by the Nevada Department of Health and 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 FA-16A by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
Download Form FA-16A Intermittent Services Prior Authorization Request - Home Health Agency - Nevada
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