Get Benefits Investigation Access Form - Neurostar Tms Therapy

The Benefits Investigation Access Form for NeuroStar TMS Therapy is an essential document that allows healthcare providers to secure necessary authorizations for treatment. This guide will assist you in completing the form accurately and efficiently when filling it out online.

Follow the steps to fill out the Benefits Investigation Access Form online.

1. Press the ‘Get Form’ button to access the Benefits Investigation Access Form and open it in your preferred editor.
2. Begin by entering the TMS physician information in the designated fields, which include the physician's name, National Provider Identifier (NPI) number, Tax Identification number (Tax ID), facility or practice name, address, city, phone, fax, TMS coordinator, and key reimbursement contact.
3. Indicate whether your office has a contract with the patient’s primary insurance by selecting 'Yes' or 'No'. If applicable, also specify if there is a secondary plan.
4. Next, fill in the patient's information including their name, date of birth, address, city, and contact numbers for home, work, and cell.
5. Attach a copy of the patient's insurance card, including both the front and back, to the form. Input details for both primary and secondary insurance, including subscriber information, group numbers, and any relationship to the subscriber.
6. Fill out the Patient Authorization section, which authorizes NeuroStar to obtain necessary reimbursement information and highlights the user's understanding of information use.
7. Complete the Orders section by providing relevant CPT and ICD-9 codes along with the anticipated number of TMS sessions.
8. Specify the site of service for treatment, notation of whether it will occur in a physician's office, hospital outpatient, or another location.
9. In the Physician Certification section, confirm that the provided information is complete and accurate, then enter the physician's full signature and the date.
10. Finally, after reviewing all entries for accuracy, save the form, and prepare to download, print, or share the completed document as necessary.

Start completing the Benefits Investigation Access Form online today!