Form F-00787 Prior Authorization Requirements Exemption Request for Computed Tomography (Ct), Magnetic Resonance (Mr), and Magnetic Resonance Elastography (Mre) Imaging Services - Wisconsin

Form F-00787 Prior Authorization Requirements Exemption Request for Computed Tomography (Ct), Magnetic Resonance (Mr), and Magnetic Resonance Elastography (Mre) Imaging Services - Wisconsin

What Is Form F-00787?

This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form F-00787?
A: Form F-00787 is a Prior Authorization Requirements Exemption Request for Computed Tomography (CT), Magnetic Resonance (MR), and Magnetic Resonance Elastography (MRE) Imaging Services in Wisconsin.

Q: What is the purpose of Form F-00787?
A: The purpose of Form F-00787 is to request an exemption from the prior authorization requirements for CT, MR, and MRE imaging services in Wisconsin.

Q: Who should use Form F-00787?
A: Healthcare providers who perform CT, MR, and MRE imaging services in Wisconsin should use Form F-00787 to request an exemption.

Q: What are CT, MR, and MRE imaging services?
A: CT (Computed Tomography), MR (Magnetic Resonance), and MRE (Magnetic Resonance Elastography) are diagnostic imaging services that use specialized technology to produce detailed images of the body.

Q: Why would someone need an exemption from prior authorization requirements?
A: A healthcare provider may need an exemption from prior authorization requirements if they have a valid reason for not being able to obtain prior authorization for CT, MR, or MRE imaging services.

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Form Details:

  • Released on February 1, 2019;
  • 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-00787 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.

Download Form F-00787 Prior Authorization Requirements Exemption Request for Computed Tomography (Ct), Magnetic Resonance (Mr), and Magnetic Resonance Elastography (Mre) Imaging Services - Wisconsin

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  • Form F-00787 Prior Authorization Requirements Exemption Request for Computed Tomography (Ct), Magnetic Resonance (Mr), and Magnetic Resonance Elastography (Mre) Imaging Services - Wisconsin

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  • Form F-00787 Prior Authorization Requirements Exemption Request for Computed Tomography (Ct), Magnetic Resonance (Mr), and Magnetic Resonance Elastography (Mre) Imaging Services - Wisconsin, Page 2

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  • Form F-00787 Prior Authorization Requirements Exemption Request for Computed Tomography (Ct), Magnetic Resonance (Mr), and Magnetic Resonance Elastography (Mre) Imaging Services - Wisconsin, Page 1
  • Form F-00787 Prior Authorization Requirements Exemption Request for Computed Tomography (Ct), Magnetic Resonance (Mr), and Magnetic Resonance Elastography (Mre) Imaging Services - Wisconsin, Page 2
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