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Durable Medical Equipment Authorization Form For SSM Health Employee Health Plan Only Fax completed form to: 3149515483 PreService Monument (Physician Signature NOT Required) PreService Administratively

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How to fill out durable medical equipment authorization

01

Obtain the durable medical equipment authorization form from your healthcare provider or insurance company

02

Fill out all required fields on the form accurately and completely

03

Provide any supporting documentation or prescription from your healthcare provider

04

Submit the completed form and documentation to the appropriate department or email address

Who needs durable medical equipment authorization?

01

Patients who require durable medical equipment such as wheelchairs, hospital beds, or oxygen tanks

02

Healthcare providers who are prescribing durable medical equipment for their patients

03

Insurance companies who need to approve and authorize coverage for durable medical equipment

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What is durable medical equipment authorization?

Durable medical equipment authorization is the approval process for certain medical equipment items that are necessary for a patient's care and treatment.

Who is required to file durable medical equipment authorization?

Healthcare providers and suppliers who prescribe or provide durable medical equipment are required to file for authorization.

How to fill out durable medical equipment authorization?

To fill out durable medical equipment authorization, healthcare providers must include detailed information about the patient, their medical condition, and the equipment prescribed.

What is the purpose of durable medical equipment authorization?

The purpose of durable medical equipment authorization is to ensure that patients receive appropriate and necessary medical equipment for their treatment.

What information must be reported on durable medical equipment authorization?

Information such as the patient's name, medical diagnosis, prescribed equipment, healthcare provider's information, and insurance details must be reported on durable medical equipment authorization form.

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