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This document outlines the preauthorization process for spinal cord stimulator procedures, including required evaluations, criteria for approval, and contraindications.
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How to fill out WYOMING WORKERS’ SAFETY AND COMPENSATION PREAUTHORIZATION CHECK SHEET SPINAL CORD STIMULATOR
01
Obtain the WYOMING WORKERS’ SAFETY AND COMPENSATION PREAUTHORIZATION CHECK SHEET for spinal cord stimulator.
02
Fill in the patient's personal information at the top section of the sheet, including their name, date of birth, and worker's compensation claim number.
03
Provide details about the medical provider, such as the healthcare facility name, address, and contact information.
04
Indicate the specific treatment or procedure being requested by marking the spinal cord stimulator option.
05
Attach relevant medical documentation, including the patient's medical history, diagnostic tests, and previous treatments.
06
Ensure all supporting physician notes and any necessary authorizations are included with the sheet.
07
Review the form for completeness and accuracy before submission.
08
Submit the filled-out preauthorization check sheet to the Wyoming Workers' Safety and Compensation office.
Who needs WYOMING WORKERS’ SAFETY AND COMPENSATION PREAUTHORIZATION CHECK SHEET SPINAL CORD STIMULATOR?
01
Workers who have sustained injuries that cause chronic pain and may benefit from a spinal cord stimulator.
02
Healthcare providers who are requesting preauthorization for spinal cord stimulators on behalf of their patients.
03
Insurance adjusters who need to review preauthorization requests for treatment related to workers' compensation claims.
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What is WYOMING WORKERS’ SAFETY AND COMPENSATION PREAUTHORIZATION CHECK SHEET SPINAL CORD STIMULATOR?
The WYOMING WORKERS’ SAFETY AND COMPENSATION PREAUTHORIZATION CHECK SHEET SPINAL CORD STIMULATOR is a document used to obtain prior approval from the Wyoming Workers' Safety and Compensation for spinal cord stimulator procedures and therapies related to workers' compensation cases.
Who is required to file WYOMING WORKERS’ SAFETY AND COMPENSATION PREAUTHORIZATION CHECK SHEET SPINAL CORD STIMULATOR?
The healthcare provider or physician recommending the spinal cord stimulator procedure is required to file the preauthorization check sheet to ensure that the treatment is covered under the workers' compensation program.
How to fill out WYOMING WORKERS’ SAFETY AND COMPENSATION PREAUTHORIZATION CHECK SHEET SPINAL CORD STIMULATOR?
To fill out the check sheet, the provider must include patient information, details about the diagnosis, medical history, the specific procedure requested, and any supporting documentation that justifies the need for the spinal cord stimulator.
What is the purpose of WYOMING WORKERS’ SAFETY AND COMPENSATION PREAUTHORIZATION CHECK SHEET SPINAL CORD STIMULATOR?
The purpose of the preauthorization check sheet is to ensure that the proposed spinal cord stimulator procedure is medically necessary and meets the criteria for coverage under Wyoming workers' compensation laws.
What information must be reported on WYOMING WORKERS’ SAFETY AND COMPENSATION PREAUTHORIZATION CHECK SHEET SPINAL CORD STIMULATOR?
The report must include the patient's personal information, the diagnosis and medical history, detailed descriptions of the recommended procedure, and any relevant treatment notes or documentation that supports the request.
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