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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-1B
for the current year.
Form FA-1B Mobility Assessment and Prior Authorization (Pa) Request - Nevada
What Is Form FA-1B?
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-1B?
A: Form FA-1B is a Mobility Assessment and Prior Authorization (PA) Request form.
Q: What is the purpose of Form FA-1B?
A: The purpose of Form FA-1B is to request prior authorization for mobility aids and equipment.
Q: Who needs to fill out Form FA-1B?
A: This form needs to be filled out by healthcare professionals or providers on behalf of their patients.
Q: What information is required on Form FA-1B?
A: The form requires patient information, details of the mobility aid or equipment being requested, and supporting documentation.
Q: What is the purpose of a mobility assessment?
A: A mobility assessment helps determine the medical necessity for a mobility aid or equipment.
Q: What type of mobility aids or equipment can be requested through Form FA-1B?
A: Form FA-1B can be used to request wheelchairs, walkers, crutches, scooters, and other mobility aids.
Q: What supporting documentation is needed for a prior authorization request?
A: Supporting documentation may include clinical evaluations, medical records, and prescriptions.
Q: What is the role of healthcare professionals in the PA request process?
A: Healthcare professionals are responsible for completing the form accurately, gathering supporting documentation, and advocating for their patients' needs.
Q: How long does the prior authorization process take?
A: The length of the prior authorization process can vary, but it typically takes a few weeks.
Q: What if a prior authorization request is denied?
A: If a prior authorization request is denied, healthcare professionals can appeal the decision or explore alternative options with the patient.
Form Details:
- Released on January 29, 2019;
- 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-1B by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
Download Form FA-1B Mobility Assessment and Prior Authorization (Pa) Request - Nevada
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