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Get Nj Horizon Health Dme Authorization Request Form 2016-2024

P or call Navinet Customer Care at 1-888-482-8057. DME Authorization Request Form Requirements: Clinical information and supportive documentation should consist of current physician order, notes and recent diagnostics. Test results must be submitted to support request for approval. Notification required for any date of service change. Fax completed form to: Horizon NJ TotalCare (HMO SNP) at 1-609-583-3013 General Information Member Name: Member ID #: Member Address: Member Phone #: DME Provi.

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