Form FA-25 Orthodontic Medical Necessity (Omn) Form - Nevada

What Is Form FA-25?

This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form FA-25?A: Form FA-25 is the Orthodontic Medical Necessity (OMN) form in Nevada.

Q: What is the purpose of Form FA-25?A: The purpose of Form FA-25 is to determine the medical necessity of orthodontic treatment.

Q: Who uses Form FA-25?A: Form FA-25 is used by orthodontists, dentists, and other healthcare professionals in Nevada.

Q: What information does Form FA-25 require?A: Form FA-25 requires detailed information about the patient's dental and medical history, as well as supporting documentation.

Q: Is Form FA-25 mandatory?A: Yes, Form FA-25 is mandatory for Medicaid patients in Nevada who are seeking orthodontic treatment.

Q: What happens after submitting Form FA-25?A: After submitting Form FA-25, it will be reviewed by the Nevada Medicaid Orthodontic Unit to determine the medical necessity of orthodontic treatment.

Q: Can Form FA-25 be used for other purposes?A: No, Form FA-25 is specific to orthodontic medical necessity in Nevada and cannot be used for other purposes.