MEDICARE REQUIRED PAPERWORK
"let Jay make it very easy for you!"
For Medical Paperwork and Medicare Questions,
please call 800-727-1954
Ask for:
Jay Rajendra, Medicare Specialist
Hours: Monday thru Thursday 10 - 6, Sat 10-4
SALES
SEAT LIFT CHAIRS
Lift Chair Instructions for Reimbursement (pdf)
Certificate of Medical Necessity Medicare Form (pdf)
Advance Beneficiary Notice (pdf)
Medical Prescription
HOSPITAL BEDS FORMS
Medical Prescription
Advance Beneficiary Notice (pdf)
Patient CHART/MEDICAL NOTES from doctor
POWER CHAIRS AND SCOOTERS
Advance Beneficiary Notice (pdf)
PERSCRIPTION
Power Chair/ Scooter: What your Doctor needs to know (pdf)
Power Chair/Scooter: Face to Face Meeting (pdf)
Power Chair/Scooter: Letter to Doctor (pdf)
FACE TO FACE REPORT
PATIENT CHART/MEDICAL NOTES
DETAILED PRODUCT DESCRIPTION
Medicare Powerchairs and Medicare
Mobility Scooters
can be at $0.00 cost
to you if you qualify for Medicare and if you have a secondary.
Please:
1. Call World's Lowest Prices at 800-727-1954.
Ask for Jay Rajendra, Medicare Specialist. He will
ask your Name, Date of Birth, Medicare Number, Name and contact
information of your Doctor. He will discuss your Mobility Issues
within your Home Environment. If Jay feels you qualify for
Medicare, he will then have our Medicare Biller, Delores Keller, call
Medicare to see if you qualify for a Medicare Powerchair or Medicare
Scooter.2. You are required to have a FACE-TO-FACE Examination with your Doctor concerning the Medical Necessity of your Power Wheel Chair or Mobility Scooter. Our Medicare Biller, Delores Keller, will notify your Doctor what the Doctor is required to do. Your Medical Records supporting your Medicare Claim will then be faxed to us: 818-332-1158
3. After your FACE-TO-FACE Examination, your Doctor's will fax his Prescription for a Powerchair or Mobility Scooter to us: fax 818-332-1158.
We can then deliver you the Powerchair or Mobility Scooter. Upon delivery, we will also take an in-home evaluation to make sure you can adequately and safely operate your Power Operated Vehicle.
If you need or desire some upgrades that Medicare does not pay for, you are required to sign an ABM form that lists items that may not covered by Medicare and the charges you are directly responsible for (example, a scooter cover is not paid for by medicare). example form: Advance Beneficiary Notice (pdf)
New Los Angeles CA theJAZZYstore serving LA Metro Area with Medicare Power Chairs. Medicare Wheelchairs are so easy to use, you are going to wonder how you ever waited so long to pamper yourself. Medicare Motorized Powerchairs allow you to move forward and reverse at the simple touch of your finger, making your day much easier, without fatigue and stress. Select a New or Used Electric Wheelchair at 1/2 OFF! for your personal use, and take a health break.
CUSTOMER INFORMATION
26 Supplier Standards (pdf)
HIPAA PRIVACY Manual (pdf)
PATIENT BILL of RIGHTS and RESPONSIBILITIES (pdf)
Falls, Fire and Home Safety (pdf)
Patient Satisfaction Survey (pdf)
For Medical Paperwork and Medicare Questions,
please call 800-727-1954
Ask for:
Jay Rajendra, Medicare Specialist
Hours: Monday thru Thursday 10 - 6, Sat 10-4
"let Jay make it very easy for you!"
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