Get the free Provider Data Collection Tool based on Anthem Corporate Medical Policy DME.00019
Show details
This document serves as a data collection tool for providers to request coverage for Continuous Passive Motion Devices based on Anthem Corporate Medical Policy. It captures patient and provider information,
We are not affiliated with any brand or entity on this form
Get, Create, Make and Sign provider data collection tool
Edit your provider data collection tool form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your provider data collection tool form via URL. You can also download, print, or export forms to your preferred cloud storage service.
How to edit provider data collection tool online
To use our professional PDF editor, follow these steps:
1
Log in to account. Start Free Trial and register a profile if you don't have one yet.
2
Prepare a file. Use the Add New button to start a new project. Then, using your device, upload your file to the system by importing it from internal mail, the cloud, or adding its URL.
3
Edit provider data collection tool. Add and change text, add new objects, move pages, add watermarks and page numbers, and more. Then click Done when you're done editing and go to the Documents tab to merge or split the file. If you want to lock or unlock the file, click the lock or unlock button.
4
Save your file. Select it from your list of records. Then, move your cursor to the right toolbar and choose one of the exporting options. You can save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud, among other things.
With pdfFiller, dealing with documents is always straightforward.
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
How to fill out provider data collection tool
How to fill out Provider Data Collection Tool based on Anthem Corporate Medical Policy DME.00019
01
Begin by gathering all necessary patient information, including demographics and insurance details.
02
Review the Anthem Corporate Medical Policy DME.00019 to understand the specific criteria and requirements for the equipment or service being requested.
03
Fill out the provider information section, including name, NPI, and contact details.
04
In the medical necessity section, provide detailed clinical information that supports the need for the requested durable medical equipment.
05
Include any relevant diagnosis codes and indicate how the equipment will assist the patient's medical condition.
06
Attach any supporting documentation such as medical records, physician notes, or previous authorization requests.
07
Ensure that all sections of the tool are completed accurately and comply with policy guidelines.
08
Review the entire document for completeness before submission.
09
Submit the Provider Data Collection Tool to the designated Anthem review committee or upload it to the specified platform.
Who needs Provider Data Collection Tool based on Anthem Corporate Medical Policy DME.00019?
01
Healthcare providers who wish to request authorization for durable medical equipment for their patients.
02
Clinicians involved in the assessment and documentation of medical necessity for DME.
03
Administrative staff managing patient referrals and authorizations within the healthcare facility.
Fill
form
: Try Risk Free
People Also Ask about
What are the medical clinical guidelines?
a. Definition: Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.
What are medical policies and clinical guidelines?
Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. These documents are available to you as a reference when interpreting claim decisions.
What do you mean by Clinical practice guidelines?
“Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”( Institute of Medicine, 1990)
What is timely filing for Anthem Wisconsin?
Timely filing is determined by subtracting the date of service from the date Anthem receives the claim and comparing the number of days to the applicable federal or state mandate.
What is the meaning of medical guidance?
Guidelines help doctors understand the best ways to diagnose, treat and even prevent diseases and conditions. Guideline recommendations are based on the strongest available scientific evidence.
What is the medical definition of guidelines?
Guidelines summarize the current medical knowledge, weigh the benefits and harms of diagnostic procedures and treatments, and give specific recommendations based on this information.
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
What is Provider Data Collection Tool based on Anthem Corporate Medical Policy DME.00019?
The Provider Data Collection Tool is a standardized form used for gathering necessary data regarding Durable Medical Equipment (DME) services as per Anthem's Corporate Medical Policy DME.00019.
Who is required to file Provider Data Collection Tool based on Anthem Corporate Medical Policy DME.00019?
Providers of Durable Medical Equipment who are seeking reimbursement or prior authorization for DME services must file the Provider Data Collection Tool.
How to fill out Provider Data Collection Tool based on Anthem Corporate Medical Policy DME.00019?
To fill out the Provider Data Collection Tool, providers must ensure to complete all required fields accurately, including patient information, equipment details, and justification for the necessity of the DME.
What is the purpose of Provider Data Collection Tool based on Anthem Corporate Medical Policy DME.00019?
The purpose of the Provider Data Collection Tool is to collect relevant data that supports the medical necessity and appropriateness of the Durable Medical Equipment being requested, ensuring compliance with Anthem's policies.
What information must be reported on Provider Data Collection Tool based on Anthem Corporate Medical Policy DME.00019?
The information required includes patient demographics, medical history, type of equipment requested, clinical justification, and any other pertinent details that demonstrate the need for Durable Medical Equipment.
Fill out your provider data collection tool online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
Provider Data Collection Tool is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.
