Documentation Requirements Library

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Qualifying clinical and sleep-test record

Document the applicable clinical evaluation, qualifying sleep test, and device-specific medical necessity criteria.

required

Continued coverage timing and adherence

For E0601 or E0470 beyond the initial three months, verify the timely treating-practitioner re-evaluation and objective adherence record when applicable.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Qualifying clinical and sleep-test record

Document the applicable clinical evaluation, qualifying sleep test, and device-specific medical necessity criteria.

required

Continued coverage timing and adherence

For E0601 or E0470 beyond the initial three months, verify the timely treating-practitioner re-evaluation and objective adherence record when applicable.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Qualifying clinical and sleep-test record

Use the diagnosis-specific Respiratory Assist Devices policy; the OSA PAP criteria do not establish E0471 coverage.

conditional

Continued coverage timing and adherence

For E0601 or E0470 beyond the initial three months, verify the timely treating-practitioner re-evaluation and objective adherence record when applicable.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.

required

Standard written order

A completed SWO must be communicated to the supplier before the claim is submitted.

required

Proof of delivery

Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.

required

Affirmative refill request and utilization

Document beneficiary contact and an affirmative refill response before dispensing. Do not deliver earlier than policy timing or exceed expected utilization.