EmpowerRide Navigator™
Documentation Guide
Clinically Engineered Mobility. Designed for Complex Needs.
Required Insurance
Documentation Guide
This guide outlines the clinical and insurance documentation typically required to obtain the EmpowerRide Navigator™, a prescription-based pediatric medical mobility device, through Durable Medical Equipment (DME) providers. Coverage is determined by medical necessity and individual insurance plan requirements.
Engineering Excellence
Overview of
Coverage Process
The EmpowerRide Navigator is obtained through a clinical evaluation and prescription process. A licensed healthcare provider must determine medical necessity and provide supporting documentation for insurance review. A qualified Durable Medical Equipment DME) provider coordinates submission and billing.
Required Insurance Documents are following.
Physician Prescription (Rx)
Order for a pediatric medical mobility device.
Clinical Evaluation
Assessment by physician, Physical Therapist (PT), or Occupational Therapist (OT).
Letter of Medical Necessity (LMN)
Clinical justification explaining why the device is medically required.
Patient Diagnosis Documentation
Medical records identifying mobility limitations and functional needs.
Functional Mobility Assessment
Documentation of limitations affecting activities of daily living.
DME Provider Intake and Insurance Information
Insurance verification and authorization forms
DME Provider Intake and Insurance Information
Insurance verification and authorization forms
Letter of Medical Necessity (LMN)
Clinical justification explaining why the device is medically required.
Letter of
Medical Necessity Requirements
Patient diagnosis and clinical history
Functional limitations and safety concerns
Need for structured mobility or positioning support
Inadequacy of standard or consumer mobility products
Expected clinical benefit and treatment goals
Length of medical need
Become A Partner
Clinical
Documentation Considerations
1
Mobility limitations impacting daily activities
2
Postural instability or positioning needs
3
Caregiver-assisted mobility requirements
4
Failure or insufficiency of existing equipment
5
Safety and medical management needs
Engineering Excellence
Regulatory and Coverage Positioning
& Submission Process
Regulatory and Coverage Positioning
- FDA-cleared pediatric medical mobility device
- Prescription-based medical equipment
- Distributed through DME providers
- Coverage subject to payer medical necessity determination
Submission Process
- Clinical evaluation by licensed provider
- Prescription and Letter of Medical Necessity completed
- Documentation submitted through DME provider
- Insurance prior authorization review
- Device delivery upon approval
Contact
Us
EmpowerRide works with clinicians and DME providers to assist with documentation preparation, provider coordination, and insurance navigation.