Wheelchair & Mobility Device Prior Authorization Request

Streamline Wheelchair and Mobility Device Prior Authorization with Paperform

Getting prior authorization for wheelchairs and mobility devices shouldn't mean drowning in paperwork. Whether you're a healthcare provider, physical therapist, or DME supplier, this Wheelchair & Mobility Device Prior Authorization Request template helps you collect all the medical documentation, clinical assessments, and insurance details needed for approval—all in one professional, easy-to-complete form.

Why This Template Works for Healthcare Providers

Prior authorization requests are notoriously time-consuming. Between gathering physician notes, physical therapy evaluations, home assessments, and insurance information, it's easy for critical details to slip through the cracks—leading to denials, delays, and frustrated patients.

This template is built specifically for medical practices, rehabilitation facilities, DME suppliers, and home health agencies that need to submit thorough, compliant prior auth requests the first time. Every field is designed around what insurance carriers actually require: detailed medical justification, functional assessments, home environment considerations, and equipment specifications.

What's Included in This Template

The form captures everything needed for a complete prior authorization submission:

• Patient and insurance information with all the policy details carriers require
• Prescribing physician details and medical specialty
• Detailed medical diagnosis and conditions requiring the mobility device
• Physical therapy evaluation including functional status, mobility limitations, and clinical measurements
• Home assessment covering accessibility, living environment, and caregiver support
• Equipment specifications for the exact device being requested
• Medical justification explaining why this specific device is medically necessary
• Supporting documentation upload for clinical notes, prescriptions, and assessment reports

Conditional logic ensures evaluators only see relevant questions based on the type of device being requested, keeping the form streamlined while capturing comprehensive details.

Perfect for Multiple Healthcare Settings

This template serves a wide range of healthcare professionals involved in the mobility device authorization process:

• Physical therapists documenting functional assessments and device recommendations
• Occupational therapists conducting home evaluations and accessibility assessments
• Physicians and specialists providing medical necessity documentation
• DME suppliers coordinating prior authorization with insurance carriers
• Home health agencies supporting patients through the approval process
• Hospital discharge planners arranging post-acute mobility equipment
• Rehabilitation facilities transitioning patients to home care

Save Time with Automation Using Stepper

Once you've captured all the prior authorization details, Stepper can automate what happens next. Connect your Paperform submission to workflows that:

• Auto-populate authorization forms in your practice management system
• Send notifications to referring physicians when additional documentation is needed
• Create tracking records in your CRM or EHR to monitor approval status
• Generate follow-up reminders if the insurance company hasn't responded within expected timeframes
• Alert the patient and care team when authorization is approved or if additional information is required

This means your administrative team spends less time on manual data entry and tracking, and more time supporting patients.

Professional, Compliant, and Conversion-Focused

Healthcare forms need to inspire confidence while remaining accessible to both clinical staff and patients. This template uses clear section headings, helpful descriptions, and a professional design that reflects the seriousness of the medical documentation process.

Paperform's SOC 2 Type II compliance and secure data handling mean you can trust that sensitive patient and insurance information is protected throughout the submission process. While Paperform is not HIPAA compliant, you can implement appropriate safeguards for your specific use case.

Flexible Enough to Match Your Workflow

Every practice has slightly different prior authorization requirements depending on insurance carriers and state regulations. With Paperform's doc-style editor, you can easily:

• Add or remove fields to match specific carrier requirements
• Adjust conditional logic based on device categories your practice commonly orders
• Customize confirmation messages with next steps and expected timelines
• Embed the form on your patient portal or website
• Connect to your existing tools via integrations with your EHR, billing system, or CRM

Whether you're a solo practitioner or part of a multi-location healthcare system, this template adapts to your authorization workflow.

Get Approvals Faster, Reduce Administrative Burden

Prior authorization denials often come down to incomplete documentation. By using a comprehensive form that captures every required detail upfront, you dramatically increase first-time approval rates and reduce back-and-forth with insurance carriers.

For healthcare providers managing dozens of authorization requests each month, that efficiency translates directly into better patient outcomes, faster equipment delivery, and less administrative overhead.

Ready to streamline your prior authorization process? Start with this template and customize it to fit your practice's specific needs. With Paperform, you get the flexibility of a custom-built solution with the speed of a ready-to-use template.