What is a Certification of Medical Necessity?

A Certification of Medical Necessity (CMN) is a detailed document completed by a healthcare provider that explains why specific medical equipment, supplies, or services are essential for a patient's treatment or condition. This certification includes the patient's diagnosis, clinical justification for the prescribed item or service, expected duration of need, and physician attestation. CMNs are particularly important for Medicare and insurance coverage of durable medical equipment (DME), home health services, and certain medications.

Why certification of medical necessity matters

• Enables insurance coverage: Required documentation for many medical equipment and service claims
• Prevents claim denials: Provides clinical justification that insurers need for approval
• Ensures appropriate care: Confirms that prescribed items meet medical standards for necessity

How Solace can help

A Solace advocate can help you understand CMN requirements for your specific equipment or services, ensure your healthcare provider completes the form correctly, and follow up on submitted certifications. Advocates can also assist with appeals if claims are denied due to CMN issues and help gather additional supporting documentation when needed.