Get Ks Bcbsks 15-405 2016-2025

The KS BCBSKS 15-405 form is essential for certifying medical necessity for supplies or medical equipment. This guide provides clear, step-by-step instructions to help you accurately complete the form online.

Follow the steps to fill out the KS BCBSKS 15-405 form with ease.

1. Press the ‘Get Form’ button to access the KS BCBSKS 15-405 form and open it in your preferred editing tool.
2. In Section 1A, enter the patient's information, including their first name, last name, phone number, middle initial, address, city, state, ZIP code, county, and date of birth. Additionally, provide the patient's height and weight.
3. Proceed to Section 1B to input the supplier information. Fill in the supplier's name, phone number, address, NPI number, city, state, ZIP code, and county.
4. In Section 1C, enter the physician information. Supply the physician's first name, last name, phone number, middle initial, address, city, state, ZIP code, county, and ID number.
5. Move to Section 2, where you will provide medical necessity information. Complete the initial certification date, diagnosis codes (ICD-10) separated by commas, revised certification date, and estimated length of need (in months). Also, include a brief description of the prescribed supply or medical equipment and list the patient's specific physical limitations or conditions relevant to the request.
6. Finally, in Section 3, the physician must attest and sign the form. The physician needs to write their signature (note that signature and date stamps are not acceptable) and the date signed.
7. After filling out all required sections of the form, save your changes. You can then download, print, or share the completed form as needed.

Complete your KS BCBSKS 15-405 form online today to ensure the swift processing of your medical equipment requests.