Effective June 25, 2010 FCA Pre-Authorization form was updated on the FCA website with the following information:

• A place for Member Address information has been added

• Clarification on the form for Insurance ID number

• CPT/HCPC Description and Numbers are now two separate line items

• A note has been added in the middle of the form, that if providers are requesting wheelchairs (power) or beds, etc., providers must use the DME pricing Pre-Auth Form.  The DME Pricing form is located on the website under Pre-Authorization.

• Clarification enhanced on the form for Referring Provider Name and ID Number

• ....and a few other small minor changes

The Pre-Authorization form can be found on the FCA website at: www.firstcoastadvantage.com under Pre-Authorization. For questions, contact FCA Provider Services at 1-866-270-2468.