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 Lidocaine Patch Prior Authorization Request Form 2017

2017-2025 Form

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Instructions and help about Lidocaine Patch Prior Authorization Request Form

welcome to this dme on demand presentation for prior authorization submitting a request package and requirements for expedited requests the information given in this training is correct as of may 2022 the most current information related to this topic can be found on the meridian dme website at the link listed on this slide the prior authorization request or pair package should include the following if required by the policy a completed pair cover sheet note this is not required when submitting a request through the noridian medicare portal or nmp a face-to-face evaluation documenting the medical necessity of the item if a face-to-face is required a written order prior to delivery or wopd if required if a wopd isn't required then a standard written order or swo should be included any additional policy specific documentation policy specific documentation can be found within the local coverage determination and policy article for the item being ordered this is a snapshot of the p

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