Service Authorization Checklists

Check It - checkmark in checkbox

Want to avoid hold-ups caused by missing information in Srv Auth requests? Check out our Service Authorization Checklists. These handy reference lists will help you determine at a glance all the information required for each service type. Don't be stuck retrieving information twice! Use the checklists for once-and-done submission!

Please limit the use of special characters in your answers and review your information after you enter it to be sure it is correct.

To view a document and then save it:
Click on the link in the document list to view the document in your browser. From the menu at the top of the browser, select FILE - SAVE AS to navigate to the folder in which you wish to save the document. Then save it.
To save the document without opening it:
Right-click the link in the document list and select "Save target as". Navigate to the folder in which you wish to save the document. Then save it.

TitleDescriptionFile SizeFile Type
(DME) Incontinence Supply checklistOOS requirments updated 2/14/1319 KB.docx
Assistive Technology ChecklistNew 10/201219 KB.docx
Bariatric Surgery Checklist(Revised 5/2012)60 KB.doc
Bone Marrow Stem Cell Transplant Checklist(Created 4/2012)84 KB.doc
Durable Medical Equipment ChecklistOOS requirements updated 2/14/201321 KB.docx
EPSDT Private Duty Nursing Services Checklist10/201215 KB.docx
Hearing Aid ChecklistNew 10/201219 KB.docx
Home Health checklistOOS requirements updated 2/14/1338 KB.doc
Incontinence Supply ChecklistPosted 02/25/2014 Attention: This Checklist may only be used by Home Care Delivered19 KB.docx
Kidney Transplant Checklist(Created 4/2012)61 KB.doc
Lung Transplant Checklist(Created 4/2012)50 KB.doc
Medical Device Services and Maintenance (MDSM)(Created 3/2012)43 KB.doc
NEOP (Imaging) CAT MRI PET checklistOOS requirements updated 2/14/1334 KB.doc
Organ Transplant Service Authorization Checklist - 0300(Created 3/2012)74 KB.doc
Outpatient Rehab ChecklistOOS requirements updated 2/14/1322 KB.docx
Pancreas Transplant Checklist(Created 4/2012)55 KB.doc
Prosthetic Device Service Authorization Checklist(Created 4/2012)51 KB.doc
Small Bowel and Multi-Viscera Transplant Checklist(Created 4/2012)56 KB.doc
Specialized Care Long Stay Hospital Checklist03/14/201324 KB.docx

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