Get Njm Precertification Form

Filling out the Njm Precertification Form online is a crucial step in obtaining necessary approvals for surgical procedures. This guide provides detailed instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the Njm Precertification Form.

1. Click 'Get Form' button to access the Njm Precertification Form and open it in the online editor.
2. Enter the request date in the designated field to document when the precertification is requested.
3. Fill in the physician's name, telephone number, and fax number to provide contact information for the medical professional overseeing the request.
4. Provide the patient's name, claim number, date of injury, adjuster name, and adjuster fax number to ensure accurate identification of the claim.
5. In the sections provided, describe the surgical procedure in detail, including any relevant documentation to support the necessity and causal relationship of the surgery, such as MRIs or office notes.
6. Specify the CPT/procedure code(s) to identify the exact procedure being requested for precertification.
7. Input the ICD-9 diagnosis code(s) relevant to the patient's condition.
8. Indicate the name of the hospital or Ambulatory Surgical Center (ASC) where the procedure is scheduled to be performed.
9. Check the box indicating whether or not an assistant surgeon, co-surgeon, or additional surgical staff will be required and provide their names if applicable.
10. If applicable, complete the section regarding post-operative care needs beyond what is included in the global fee package.
11. Indicate whether inpatient admission or same-day surgery is required by selecting the appropriate option.
12. Specify the proposed surgery date to provide clarity on the timeline for the procedure.
13. After completing all sections, review the form for accuracy. Users can then save changes, download, print, or share the completed form as needed.

Complete your Njm Precertification Form online today to streamline the approval process for your surgical needs.