Form FA-12 Prior Authorization Request - Inpatient Mental Health - Nevada

What Is Form FA-12?

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

FAQ

Q: What is Form FA-12?
A: Form FA-12 is a Prior Authorization Request form for Inpatient Mental Health services in Nevada.

Q: Why is a Prior Authorization Request needed?
A: A Prior Authorization Request is needed to obtain approval from the insurance company before receiving inpatient mental health services.

Q: What information is required on Form FA-12?
A: Form FA-12 requires information about the patient, the diagnosis, the requested services, and the treating physician.

Q: Who should fill out Form FA-12?
A: The treating physician or the healthcare provider responsible for the patient's mental health care should fill out Form FA-12.

Q: How long does it take to get a response after submitting Form FA-12?
A: The response time can vary, but typically insurance companies provide a response within 5 business days.

Q: What happens if my Prior Authorization Request is denied?
A: If your Prior Authorization Request is denied, you may have the option to appeal the decision or explore alternative treatment options with your healthcare provider.

Q: Are there any fees associated with submitting Form FA-12?
A: Fees vary depending on your insurance plan. It is recommended to review your insurance policy or contact your insurance provider for more information.

Q: Is Form FA-12 specific to Nevada?
A: Yes, Form FA-12 is specific to the state of Nevada for inpatient mental health services.