Minnesota Medicaid Funding Forms
Required Funding Forms
These forms are required by your state’s Medicaid program in addition to the standard funding forms listed below. Please make sure to download all forms as a PDF and fill in the forms electronically. Save as needed before submitting to Forbes AAC.
This form is required by Minnesota Medicaid when requesting authorization for augmentative communication devices and accessories.
Use the link above to access the form required by Minnesota Medicaid when requesting authorization for augmentative communication devices and accessories. You may get a message that your Adobe Acrobat Reader needs to be updated. If you are still unable to access the form try using a different browser such as Firefox.
You may need to open the file with the option that appears in the upper right corner of the browser that says "Open with different viewer". Click that button and a window will appear with two choices, 'Open with' or 'Save file'. Either choice will work as indicated by their respective commands.
Minnesota Medicaid requires that the client have a face-to-face examination with their physician no more than 6 months prior to the written order for the speech generating device (SGD). The physician must document that the client was evaluated and/or treated for a condition that supports the SGD. This documentation (chart notes or office visit notes) must be provided along with the written order for the SGD.
Standard Funding Forms
The forms listed below must be received to complete your funding packet request. Once we have received all of the listed items, a funding expert will review your documentation to determine if any alterations are required prior to submission. We encourage all of our customers to reach out to us with any questions that you may have! NOTE: Spanish forms are available for the Client Information Form, the Feature Unlock Key and the Release of Information (ROI) and Assignment of Benefits Form (AOB).
Contact your local funding specialist
Forbes AAC has a fully staffed funding team ready to assist you. We dedicate associates to specific geographic regions so that you can contact a local expert throughout the funding process.
By dedicating our experts on a regional basis, we provide you with a trusted partner to maximize our clients' likelihood for obtaining funding.