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This version of the form is not currently in use and is provided for reference only. Download this version of
Form FA-25
for the current year.
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 the Form FA-25 Orthodontic Medical Necessity (OMN) Form?A: The Form FA-25 is a document used in Nevada to determine the medical necessity of orthodontic treatment.
Q: What is orthodontic treatment?A: Orthodontic treatment involves the use of braces or other appliances to correct and align teeth.
Q: Who uses the Form FA-25?A: The Form FA-25 is used by orthodontists and dental providers in Nevada.
Q: Why is the Form FA-25 used?A: The Form FA-25 is used to assess the medical necessity of orthodontic treatment and determine if it should be covered by insurance.
Q: What information is required on the Form FA-25?A: The form requires information about the patient's dental history, diagnosis, and treatment plan.
Q: Is the Form FA-25 specific to Nevada?A: Yes, the Form FA-25 is specific to Nevada and is not used in other states.
Q: Can I fill out the Form FA-25 myself?A: No, the Form FA-25 must be completed by a qualified orthodontist or dental provider.
Q: What happens after submitting the Form FA-25?A: After submitting the form, the insurance company will review the information and determine coverage for orthodontic treatment.
Q: Is orthodontic treatment always covered by insurance?A: Coverage for orthodontic treatment varies among insurance plans, and medical necessity must be demonstrated.
Q: Can I appeal a denial of coverage for orthodontic treatment?A: Yes, if your insurance denies coverage, you can appeal the decision.
Q: Are there any alternatives to the Form FA-25?A: Some insurance companies may accept alternative forms or documentation for assessing the medical necessity of orthodontic treatment.
Q: What should I do if I have more questions about the Form FA-25?A: If you have more questions, it is best to reach out to your orthodontist or dental provider in Nevada for assistance.
Form Details:
- Released on October 1, 2020;
- The latest edition provided by the Nevada Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form FA-25 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
Download Form FA-25 Orthodontic Medical Necessity (Omn) Form - Nevada
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