Instructions for Form F-11039 Prior Authorization / Spell of Illness Attachment (Pa / Soia) - Wisconsin

This document contains official instructions for Form F-11039 , Prior Authorization/Spell of Illness Attachment (Pa/Soia) - a form released and collected by the Wisconsin Department of Health Services.

FAQ

Q: What is Form F-11039?
A: Form F-11039 is a Prior Authorization/Spell of Illness Attachment (PA/SOIA) form in Wisconsin.

Q: What is the purpose of Form F-11039?
A: The purpose of Form F-11039 is to request prior authorization for medical services or to document a spell of illness.

Q: Who needs to use Form F-11039?
A: Healthcare providers in Wisconsin need to use Form F-11039 to request prior authorization or document a spell of illness.

Q: How do I use Form F-11039?
A: You need to complete the form with the necessary information, including patient details, medical services being requested, and supporting documentation.

Q: Is there a fee for submitting Form F-11039?
A: No, there is no fee for submitting Form F-11039.

Q: How long does it take to process Form F-11039?
A: The processing time for Form F-11039 varies. It is recommended to submit the form well in advance to allow for processing time.

Q: Are there any specific requirements for completing Form F-11039?
A: Yes, you must provide accurate and complete information, as well as any required supporting documentation, to ensure proper processing.

Q: Who should I contact if I have questions about Form F-11039?
A: If you have questions about Form F-11039, you can contact the Wisconsin Department of Health Services or your healthcare provider.