Electronic Certificate of Medical Necessity

For medical practices that complete Certificates of Medical Necessity forms you can choose these options:

• Copied form mailed in with paper claim
• Faxed form
• Electronic claim transmission - CMN documentation sent electronically with claim.

Contact your Practice Management software or Clearinghouse to identify if they currently support the electronic claim transmission format. Also, be aware that your office should still complete a paper CMN form and keep in the patients chart files with the providers signature or scanned in the patients chart files with your PM software.

If claims are submitted electronically and DMERC feels that something has been falsified or is incorrect they can request a copy of the original signed documentation at any time. Your medical office will be required to supply the paper form at this time for claims payment.

To locate the CMN forms please visit: http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp#TopOfPage and follow these steps:

1. Check mark Show only items containing this word: Certificate

2. Click Show Items

**Everything will pull except for the DME Information Form - External Infusion Pump DME 09.03 (go back to the Show only items and enter DME 09.03 and click Show Items again)

All forms needed:

CMS 484 Certificate of Medical Necessity - Oxygen DME 484.03

CMS 846 Certificate of Medical Necessity - Pneumatic Compression Device DME 04.04B

DME 847 Certificate of Medical Necessity - Osteogenesis Stimulators - DME 04.04C

DME 848 Certificate of Medical Necessity - Transcutaneous Electrical Nerve Stimulator (TENS) - DME 06.03B

CMS 849 Certificate of Medical Necessity - Seat Lift Mechanisms - DME 07.03A

CMS 854 Certificate of Medical Necessity - DME 11.02

CMS 10125 DME Information Form - External Infusion Pumps DME 09.03

CMS - 10252 Instructions for completing the Certificate of Data Destruction for Data aquired from the centers for Medicare & Medicaid Services

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