Effective February 9, 2016, the revised Attending Provider Treatment Plan form shall be used by all Providers to submit Decision Point Review and Pre-certification Requests. To obtain a copy of this form, click on this link.
Can the Uniform Attending Provider Form be submitted by a DME provider with a note from the treating physician or chiropractor concerning the medical necessity of the equipment?
Although a DME vendor is defined as a provider in N.J.A.C. 11:3-4, it was not the intention of the Department that DME vendors submit the Uniform Attending Provider Form to payors. DME vendors don’t treat patients or make diagnoses. The attending provider needs to set forth the diagnosis(es) and clinically supported findings on the Uniform Attending Provider Treatment Form and sign the form with its Statement and Fraud Prevention Warning. The DME vendor or other non-treating provider can then provide the equipment or services that have been determined to be medically necessary.
No spaces on the form are provided for co-morbidities/treatment complications that are relevant to a Decision Point Review or Precertification request. How should this be handled by providers?
The Uniform Attending Provider Form is not intended to include ALL the information that is submitted with a Decision Point Review or Precertification request. It should be accompanied by SOAP notes, test results and other information related to the request, including how co-morbidities or treatment complications that affect the treatment or testing requested.