The Cochlear implant order form is the document your audiology clinic (or you, with the clinic’s help) submits to Cochlear Americas to request a new sound processor system, an upgrade, or a replacement for a lost or damaged processor. Download the correct form for your device from Cochlear’s professionals page, fill in the recipient, clinic, and product sections, and send it in with your insurance card, an Authorization and Assignment of Benefits form, and any clinician documentation Cochlear asks for. Submissions go through the myCochlear Clinic portal, by fax to 303-790-1157, or by email to procare@cochlear.com.1Cochlear. Bimodal Solution Order Form
Pick the Right Form for Your Device
Cochlear uses a different form for each device family and each type of transaction. Grabbing the wrong one is the most common early misstep, and it sends the paperwork back before the process even starts. All forms are available as downloadable PDFs from Cochlear’s order forms page for professionals in English and Spanish, with French versions for some Canadian recipients.2Cochlear. Cochlear Order Forms for Professionals
- Nucleus: Nucleus Nexa System Order Form (new systems, with a pediatric version), Nucleus 8 Upgrade Order Form, and Nucleus 8 Nexa Sound Processor Replacement Order Form.
- Kanso: Kanso 3 Upgrade Order Form and Kanso 3 Nexa Sound Processor Replacement Order Form.
- Baha: Baha 7 System Order Form for initial systems and individual components, Baha 7 Upgrade Order Form, and Baha 7 Sound Processor 90-Day Exchange Form.
- Osia: Osia Sound Processor Replacement Order Form.
- Nucleus and Kanso Sound Processors 90-Day Exchange Form for a swap within the first 90 days.
If you’re a patient, your audiologist’s office can pull and print the right form. You can also download it yourself and bring it to your appointment for completion.
Get Your Information Together First
Orders stall most often because a document arrives incomplete or an insurance ID is transposed. Assembling the following before you touch the form is the single biggest time-saver:3Cochlear. Frequently Asked Questions
- Your audiology clinic name, your audiologist’s name, and your ENT or hearing specialist’s name.
- Insurance company, member ID, and group number, plus a copy of your insurance card. Include both primary and secondary coverage if you have them.
- An emergency contact name and phone number for someone outside your household.
- Parent or guardian name and phone number if the recipient is under 18.
- Which side the implant is on, left or right.
- The reason for the order: new system, upgrade, replacement of a broken unit, or a loss.
- A completed Authorization and Assignment of Benefits (AOB) form, which lets Cochlear bill your insurer directly. If you already have an AOB on file, some other paperwork (the emergency contact and clinic consent) may not be needed again.
- Clinic consent if the clinic is placing the order for you. This can be given verbally, by email, or through DocuSign, and is not required when an AOB is on file.
- A Back-in-Sound Consent form if Cochlear asks for one; it isn’t required for every order.
- A signed Financial Consent form once Cochlear sends you the out-of-pocket estimate.
Filling Out the Form Section by Section
Every Cochlear order form uses roughly the same layout. Using the Nucleus 8 Upgrade Order Form as the model:4Cochlear. Cochlear Nucleus 8 Sound Processor Upgrade Order Form
Recipient Information
The first section covers the person who will wear the device: full name, email, phone, mailing address, and date of birth. There are fields for gender, implant side, preferred language, and an emergency contact. A guardian field appears if the recipient is a child. Write your name exactly as it appears on your insurance card. Mismatches between the order form and insurance records are a common cause of billing delays.
Clinic Information
The next section identifies the clinical team: clinic name, clinic email, audiologist name, and MD or ENT physician name. There are also fields for a purchase order number if the clinic uses internal PO tracking, along with billing and shipping addresses and space for special shipping instructions.
Product Selection
The remaining sections vary by form and cover the hardware itself. Upgrade forms ask for the sound processor model, processor color, and battery choice (rechargeable module or disposable zinc-air cells). Coil length, cable type, and magnet strength must match your internal implant. Your audiologist has the correct specifications from your device history. If you’re unsure about any hardware choice, leave the field blank and let the clinic complete it. An incorrect coil length or magnet strength means the external processor will not couple properly with the internal implant.
Documents That Go With the Form
The form alone is not enough. Missing supporting paperwork is what most often holds an order up.
Insurance Card and AOB
Submit a clear copy of the front and back of your insurance card along with the completed AOB. If you have both primary and secondary coverage, include cards and details for both.
Letter of Medical Necessity
For many orders, especially upgrades and new systems, Cochlear may need a Letter of Medical Necessity from your clinician. The LMN explains why the specific device is required for your hearing rehabilitation and is the main document insurers review when deciding coverage. Your audiologist or ENT typically drafts it, and Cochlear’s insurance support team may contact your clinician directly if one is not included with the order.5Cochlear. Cochlear Implant Payment Process
Financial Consent
If insurance won’t cover the full cost, Cochlear sends a Financial Consent form with an estimate of your out-of-pocket responsibility. You sign and return it before the order ships. The order will not move to fulfillment without it.
How to Submit the Order
Once the form and supporting documents are together, you can send them through any of three channels:
- The myCochlear Clinic portal at myCochlear.com. Audiologists and clinic staff can log in to manage patient orders, log repair and replacement requests, and view warranty and equipment information. This is the fastest route for clinician-initiated orders.6Cochlear. myCochlear Clinic Account Registration
- Fax to Cochlear’s order management team at 303-790-1157. Clinics that want a paper confirmation trail still prefer this route.
- Email to procare@cochlear.com.
If you get stuck or aren’t sure which form to use, Cochlear Americas customer support answers at 877-651-7001, Monday through Friday from 6:00 a.m. to 6:00 p.m. MDT and Saturday from 8:00 a.m. to noon.7Cochlear. Cochlear Device Support
What to Expect After Submission
For orders billed to insurance, Cochlear’s Otologic Management Services team handles preauthorization with your health plan. Health plans typically take 15 to 45 days to respond to a preauthorization or predetermination request, and appeals of a denial can take longer. The OMS team can also assist with an appeal.8Cochlear ProNews. Help Your Patients Access Insurance Support Services Through Cochlear
Once insurance clears, or once payment is confirmed for a self-pay order, the order moves to fulfillment. Parts and accessories typically ship within two to four weeks. Sound processor upgrades usually arrive about six to eight weeks after order placement, a window that includes both insurance review and physical shipping.9Cochlear. Supporting Patient Upgrades Self-pay orders can arrive sooner.
Warranty and Loss Coverage That Come With the Order
The warranty attached to your new processor depends on whether it’s part of a brand-new implant system or an upgrade. New-system warranties run five years for the Nucleus 8 Nexa, Kanso 3 Nexa, Nucleus 8, Kanso 3, Kanso 2, Osia 2, Baha 7, and Baha 6 Max. Upgrade warranties run three years for the Nucleus and Kanso families (including the Nucleus 7 for N22 implants) and two years for Osia and Baha upgrades.
Warranty coverage also includes one-time loss replacement per device, per side. If your processor goes missing, Cochlear replaces it at no charge, but only once. After that, loss coverage on that device is gone. You can check your current warranty status and expiration in the Cochlear Family online portal, and extended warranties are available for purchase when the original period ends.10Cochlear. Warranty Coverage