Follow the steps to successfully complete the Odm01913 online.

1. Click ‘Get Form’ button to obtain the Odm01913 and open it in the editor.
2. Enter the provider's name and their National Provider Identifier (NPI) number at the designated fields.
3. Fill in the Medicaid Legacy number if applicable.
4. Provide the consumer's name and date of birth in the respective sections.
5. Complete the billing number and the height/weight fields.
6. Indicate the type of certification you are submitting: Initial Certification, Recertification, or Change, and provide the relevant prior authorization numbers if applicable.
7. In Section A, provide detailed medical necessity information, including the diagnosis and ICD-9 codes. Specify the type and number of tests or procedures for supplies required.
8. Fill out the item codes, total units required, the way the item is provided, and the total overage units requested.
9. Complete the description of tests or procedures and any special considerations related to the request.
10. Indicate the start and end dates for the requested supplies.
11. In Section B, the individual completing the form must print their name, certify their identity, and provide their signature and date.
12. If applicable, the prescriber must complete Section C by printing their name, signing, and dating the form to certify the medical necessity.
13. Review all filled information for accuracy before final submission.
14. Once completed, users can save the changes, download the form for their records, print it, or share it as needed.

Complete the Odm01913 online today to ensure timely processing of your medical supply needs.