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BNYCb Healthline Fax Authorization Request Empire Blue Cross Bb 2016
Healthline for check one service per fax form Inpatient acute Inpatient rehabilitation Maternity NICU Skilled nursing facility Admission date MMDDYYYY Sex M Emergency Ambulatory surgery Air ambulance Cardiac rehabilitation DME or prosthetics Genetic testing First date of service MMDDYYYY No. of visits requested Scheduled Infertility service Outpatient therapy Radiology therapy Specialty drugs PT ST Additional services continue to require precertification by EmblemHealth. Providers should call...
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