Precertification Request - Home IV Therapy

The Precertification Request - Home IV Therapy form should be used to:

• Precertify benefits prior to starting Home Inotropic Infusion Therapy - Administrative Information, Intravenous Immune Globulin (IVIG) Therapy - Administrative Information - IV Therapy Index, and Home Pain Management Therapy - Administrative Information
• Precertify benefits if therapy is expected to extend beyond the Standard Duration for the therapy
• Precertify nursing visits during the extended therapy period.

Click here to access the Precertification Request - Home IV Therapy Form [PDF].

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