What information is required on a DME/Supply order?
Date
Patient's legal name
Patient's date of birth
DME-related diagnosis and associated ICD-10 codes
Provider's NPI number
Requested DME/Supply product(s)
Length of need/# of refills
Provider signature with date
In what circumstances is additional information required?
HEAVY DME items (wheelchair, hospital bed, lifts, etc.) will need to include:
Member height and weight
Provider reason for the DME item
Associated provider progress notes/chart notes
WOUND CARE items will need to include:
# of refills (if applicable)
Associated provider progress notes/chart notes
Location and measurements of the wound
*Note that a new order is required for continuations (continuation is needed after all refills have been utilized).
What happens if any information is missing?
If any information is missing, the DME/Supply request will not be approved. It will be sent back, and the missing information will need to be included and the order resubmitted.
The health plan does not determine what information is required. That is determined by the regulatory agencies that oversee the prescription fulfillment process. The health plan must follow the guidelines set forth by these agencies.
Therefore, if the DME/Supply request is missing any required information, the health plan is obligated to reject it for being incomplete.
If an order is rejected for being incomplete, the health plan takes action to help your loved one. The health plan makes several attempts (phone, fax) to contact the ordering provider. During this time, you and your loved one are also encouraged to contact the provider. If after these attempts the provider has not resubmitted a corrected order, the health plan will notify the member and the provider by mail.
After that point, a new DME/Supply request will need to be submitted.
Approval determination
Once a proper DME/Supply request is received, the health plan has a limited amount of time - typically up to 14 days - to determine approval.
Many health plans do not communicate that the order has been approved. Your loved one is likely to find out that the order has been approved when the supplier contacts them to report that their order has been received or is being filled or is being shipped.
Is your loved one on a VNS Health plan?
If yes, and you have an electronic or hard copy DME order in hand, you can click here to submit that DME/Supply order directly through the DME benefit in our app.
No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Likewise, no content in this app, regardless of date, should ever be used as a substitute for direct advice from a licensed insurance broker or other qualified plan-payer professional.
