Mynexus form 2025

1. Click ‘Get Form’ to open the mynexus form in the editor.
2. Begin by entering the 'Date of Request' at the top of the form. Specify whether it is a Standard or Retro Request.
3. Fill in the 'Member Name' and indicate if this is an Urgent Request, ensuring you understand the criteria for urgency.
4. Complete the 'Referral Source' section, including name, NPI, and phone number. Select the appropriate referral source from the options provided.
5. Input the 'Member ID#', 'DOB', and 'Fax' information accurately to ensure proper identification.
6. Provide details about the preferred home health provider and indicate if home health care has already begun.
7. Detail the diagnosis, ordering MD information, and any applicable HIPPS codes.
8. Specify what services are being requested (e.g., Skilled Nursing, PT) along with reasons for visits and any additional comments or notes.

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