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Durable Medical Equipment (DME)
Provider Manual & Certification Forms
TABLE OF CONTENTS
Effective Date 8/31/05

  

To view the following publications, you will need Adobe Acrobat Reader. To download, click here.
 

  1. INTRODUCTION
     

  2. Mission Statement I-A (1)

  3. Key Personnel I-B (1)

  4. Overview of Program I-C (1-5)

     

    5.

  5. REVIEW ACTIVITIES TAB II
     

  6. Certification Review II-A (1-8) 

  7. Retrospective Review II-B (1-9)

  8. Reconsideration Process II-C (1-3)

  9. Reconsideration Review Request Form (1 pg)

  10. Instructions Reconsideration Review Request Form (1pg)
     

    11.

  1. QUALITY ASSURANCE/UTILIZATION REVIEW TAB III
     

  2. 5% Quarterly Quality Sample III-A (1-3)

  3. Quality Re-review Process III-B (1-3)

  4. Provider/Beneficiary Hot-line Process III-C (1-4)

  5. Quality Intervention Process III-D (1-4)

  6. Quality Screens/Indicators III-E (1)

  7. Quality Intervention Committee Issue Weighting and Intervention Policy III-F (1-5)

  8. Quality Re-review Request Form (1 pg)

  9. Instructions Quality Re-review Request Form (1 pg)

  1. CRITERIA, CERTIFICATE OF MEDICAL NECESSITY FORMS, AND PLAN OF CARE FORMS

Please refer to the Mississippi Division of Medicaid's Web site for this information @ http://www.dom.state.ms.us.

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