Get The Neocate

Completing the Neocate Assistance Program (NAP) application online can be a straightforward process when guided step by step. This guide will provide you with clear, detailed instructions to successfully fill out the form and ensure you provide all necessary information.

Follow the steps to complete your NAP application.

1. Press the ‘Get Form’ button to access the Neocate application form and open it in your preferred editing tool.
2. Begin by completing Part 1 titled 'Information From Physician.' Ensure this section contains accurate details including the physician's name, license number, and contact information. This portion may be filled out by the physician or their designated office staff but must include the physician's signature.
3. In Part II, 'Information from Applicant,' fill in your personal details such as full name, Social Security number, date of birth, and contact information. Make sure to check the box if your address has recently changed.
4. Provide your monthly household income information. Include all sources of income from every household member. You will need to attach documentation supporting this income.
5. Include information regarding any health benefits that the applicant may have. This includes Medicare enrollment status and whether coverage for nutritional therapy has been denied. Provide supporting documents as specified.
6. If applicable, attach any denial letters for financial assistance programs like Medicaid or WIC. Ensure that all required documents are included to avoid any delays.
7. Review the certification section at the end of the application. It is essential that you sign and date this section to confirm that all provided information is accurate.
8. Once you have completed all required sections and attached necessary documentation, submit the form either by fax or through the mail to the address provided by Nutricia for eligibility review.
9. After submission, await confirmation from Nutricia regarding your application's status. If approved, they will begin the product fulfillment process and notify you accordingly.

Complete your Neocate Assistance Program application online today for a smoother, more efficient experience.