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Get and Sign Kansas Inpatient Medicaid Prior Authorization Fax Form Inpatient Medicaid Prior Authorization Fax Form 2015

Get and Sign Kansas Inpatient Medicaid Prior Authorization Fax Form Inpatient Medicaid Prior Authorization Fax Form 2015

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Additional Procedure Code Discharge Date if applicable otherwise Length of Stay will be based on Medical Necessity Additional Diagnosis Code Modifier INPATIENT SERVICE TYPE Enter the Service type number in the boxes Long Term Acute Care Medical Nursing Facility Residential/Custodial Care Premature/False Labor Skilled Nursing Facility Sub-Acute Surgical Transplant Surgery Work-up Delivery C-Section Vaginal Delivery Inpatient Rehab Inpatient Hospital Comprehensive Inpatient Rehab Facility ALL...
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