Get Cpap Bipap Bcertificateb Of Medical Necessity - Upmc Health Plan

This guide provides clear and concise instructions on filling out the CPAP BiPAP Certificate of Medical Necessity form for UPMC Health Plan. By following this comprehensive step-by-step guide, users can ensure accurate completion of the form online for efficient processing.

Follow the steps to complete the form accurately online:

1. Press the ‘Get Form’ button to access the document and open it in your chosen editor.
2. Begin by entering the patient’s last name and first name in the respective fields.
3. Fill in the patient's date of birth using the format ____/____/____.
4. Enter the Subscriber ID number accurately in the designated space.
5. Include the diagnosis along with the corresponding ICD-9 code in the appropriate area.
6. Indicate the C-PAP/BiPAP start date using the format ____/____/____.
7. Specify whether a sleep study was performed prior to the initiation of therapy by checking 'Yes' or 'No'.
8. If applicable, input the date of the sleep study using ____/____/____.
9. Determine if obstructive sleep apnea is present by checking one or both options regarding the Apnea-Hypopnea Index.
10. Select one or more options that relate to excessive daytime sleepiness, documented hypertension, or other relevant conditions.
11. If applicable, assess and check options regarding Central Sleep Apnea, Restrictive Thoracic Disorders, or Chronic Obstructive Pulmonary Disease.
12. Record the date of compliance check, ensuring it is no sooner than 61 days after therapy initiation.
13. Finally, enter the Odometer or Smart Card Reading in the provided field.
14. Review all entries for accuracy. Once verified, proceed to save changes, and download, print, or share the completed form as needed.

Complete your documentation online confidently and ensure a smooth process.