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How to fill out the Looking For Masshealth To Cover Pads Form online
Filling out the Looking For Masshealth To Cover Pads Form online can be a straightforward process when guided properly. This guide provides clear instructions on each section of the form, ensuring users complete it accurately to obtain the necessary medical coverage.
Follow the steps to successfully complete the online form.
- Click ‘Get Form’ button to access the document and open it for editing.
- In Section 1, provide the member's name, address, city, MassHealth ID number, date of birth, gender, height, weight, and the primary and secondary ICD-9 codes with their descriptions. Ensure all information is accurate.
- In Section 2, enter the prescribing provider's name, address, telephone number, and NPI.
- In Section 3, fill in the details for the provider of Durable Medical Equipment (DME), including their name, address, telephone number, and NPI.
- In Section 4, checkmark the requested items and provide the corresponding size, HCPCS code, and any modifiers.
- Complete Section 4A by entering daily units, number of monthly refills, and length of need for each type of absorbent product requested.
- For Section 6, the prescribing provider or their staff must answer the medical necessity questions as applicable. Attach supporting documentation as required.
- Section 5 requires the DME provider’s attestation, including their signature and the date of completion.
- In Section 7, the prescribing provider must sign and date the form, certifying the information provided is accurate. Check the applicable credentials.
- Review the completed form for accuracy. Once satisfied, save your changes, and consider downloading, printing, or sharing the form as needed.
Complete your forms online today to streamline the process for obtaining necessary absorbent products.
The number for MassHealth is 800-841-2900, which is essential for inquiries and support. By calling this number, you can speak with representatives who can guide you regarding your health coverage, including specifics about the MassHealth to cover pads form. It's a reliable resource for anyone seeking assistance with their health care needs.
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