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Elizabeth M. Whitehorn, Director

Provider Notice issued 09/11/09

Revisions to DME Questionnaires and Prior Approval Form

To:​ Participating Durable Medical Equipment Providers, Hospitals, and Pharmacies​
Date:​ September 11, 2009​
Re:​ Revisions to DME Questionnaires and Prior Approval Form ​

The department has recently made the following form changes impacting DME providers.  All forms referenced are available on the department’s Web site at: http://www.hfs.illinois.gov/medicalforms/

 

  • The department has merged the HFS 2240 – Equipment Prior Approval Request into a revised HFS 1409 Prior Approval Request.  DME providers must now utilize the HFS 1409 instead of the HFS 2240 for all prior approval requests.  Instructions for completion are included with the HFS 1409 on the Web site.  The department will not accept the obsoleted form HFS 2240 after September 30, 2009.
  • The department has created a new form, the HFS 3905, Hospital Bed Questionnaire, which should be used any time a prior approval for a hospital bed is requested.  Providers should begin using this form immediately.  HFS 1409 Prior Approval Requests for hospital beds will be returned if form HFS 3905 is not also submitted.    
  • The HFS 3701F, CPAP/BIPAP Questionnaire, has been revised to include heated and non-heated humidification.  Providers should start using the revised form immediately.
  • The Required Documentation instruction sheet for completion of the HFS 3701K and HFS 3701H forms has been updated to include some additional language.  Changed areas are identified by "=" marks to the left of the affected text.  This instruction sheet is placed with each of these forms on the Web site. 

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs