Effective immediately, providers should complete a correction request form if a change is needed to information that was submitted on the preauthorization request, such as provider name and number or dates of service. If a change is needed, please complete the Audiology Correction Request Form and fax it to Telligen at 1-888-297-4276. This form can also be found at the following websites:
Please do not submit a new review request through Qualitrac in order to make a correction to a previously submitted preauthorization request. This will create a duplicate preauthorization number which may cause delays in payment. If you have any questions, please contact Stephanie Hood at 410-767-3998 or email stephaniehood@maryland.gov.