Durable Medical Equipment Authorization Request 2015 free printable template

Durable Medical Equipment Authorization Request Fax # 18002154901All Prior Authorization requests must either be faxed on this template or be submitted through the Web Bill Processing Portal (https://owcpmed.dol.gov).

How to fill out Durable Medical Equipment Authorization Request

How to fill out Durable Medical Equipment Authorization Request

1. Obtain the Durable Medical Equipment Authorization Request form from your healthcare provider or insurance company.
2. Fill in patient information including name, date of birth, and contact details.
3. Include the prescribing physician's information and their National Provider Identifier (NPI) number.
4. Specify the durable medical equipment (DME) needed, including the type and quantity.
5. Provide relevant medical history and documented need for the equipment.
6. Attach any supporting documentation such as medical records or prescriptions.
7. Review the completed request for accuracy and completeness.
8. Submit the form to the insurance provider and keep a copy for your records.
9. Follow up with the insurance provider to check the status of the authorization request.

Who needs Durable Medical Equipment Authorization Request?

1. Individuals who require medical equipment for daily living activities due to chronic illness, injury, or disability.
2. Patients prescribed DME by a healthcare professional to manage their health condition effectively.
3. Individuals seeking insurance coverage for durable medical equipment such as wheelchairs, walkers, or oxygen equipment.

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What is Durable Medical Equipment Authorization Request?

A Durable Medical Equipment Authorization Request is a formal process by which healthcare providers seek prior authorization from insurance companies to ensure that specific durable medical equipment (DME) will be covered under a patient's insurance plan.

Who is required to file Durable Medical Equipment Authorization Request?

Typically, healthcare providers, such as physicians or therapists, are required to file the Durable Medical Equipment Authorization Request on behalf of the patient to obtain approval for coverage from the insurance company.

How to fill out Durable Medical Equipment Authorization Request?

To fill out a Durable Medical Equipment Authorization Request, the provider must accurately complete required information such as patient details, medical necessity, specific equipment needed, and supporting documentation, then submit it to the insurance provider.

What is the purpose of Durable Medical Equipment Authorization Request?

The purpose of the Durable Medical Equipment Authorization Request is to verify that the requested DME is medically necessary for the patient's condition and to ensure that the costs will be covered by the patient's insurance plan.

What information must be reported on Durable Medical Equipment Authorization Request?

The information that must be reported includes the patient's personal and insurance details, a description of the durable medical equipment requested, the diagnosis, the justification for need, and any relevant medical history or supporting documentation.