Procedures for Requesting Dme Medical Supplies and Equipment

Procedures for Requesting Dme Medical Supplies and Equipment

(REVISED) PROCEDURES FOR REQUESTING DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES (DMEPOS) VIA MEDICARE PART B AND DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) 1 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES B E N E F I C I A R I E S W H O A R E C L A SS I F I E D A S M E D I C A R E PA R T B O R D U A L ELIGIBLE/DUAL ELIGIBLE (QMB) MUST H AV E T H E I R P R I O R A U T H O R I Z AT I O N REQUEST(S) FOR DMEPOS SUPPLIES/ EQUIPMENT SUBMITTED TO

M E D I C A R E F I R S T, A S M E D I C A R E PA R T B IS THE FIRST INSURER AND FOR D U A L S - - PA R T B I S T H E F I R S T INSURER ALSO, WITH DC MEDICAID BEING THE SECOND INSURER FOR DUALS. 2 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES BEFORE PROCEEDING WITH THE INSTRUCTIONS ON THE F O L L O W I N G PA G E S , P L E A S E V E R I F Y T H E B E N E F I C I A RY S

INSURANCE ELIGIBILITY/COVERAGE VIA DC M E D I C A I D W E B P O RTA L O R V I A INTERACTIVE VOICE RESPONSE ( I V R ) AT 2 0 2 - 9 0 6 - 8 3 1 9 . 3 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES FOR ALL DMEPOS S U P P L I E S / E Q U I P M E N T, T H E B E N E F I C I A RY M U S T O B TA I N A PRESCRIPTION (NOT A 719A F O R M ) F R O M T H E I R AT T E N D I N G

PHYSICIAN WITH MEDICAL J U S T I F I C AT I O N ; A N D I N S O M E I N S TA N C E S M E D I C A L C H A RT NOTES. FOR SOME E Q U I P M E N T / S U P P L I E S , A FA C E T O - FA C E W I T H T H E P C P M AY B E 4 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES T H E B E N E F I C I A RY G I V E S T H E PRESCRIPTION, MEDICAL J U S T I F I C AT I O N A N D M E D I C A L C H A RT N O T E S ( I F R E Q U I R E D ) T O A C E RT I F I E D M E D I C A R E D M E P O S

SUPPLIER OF THEIR CHOICE. N O T E : A S A P R OV I D E R , YO U S H O U L D A LWAY S G I V E T H E B E N E F I C I A RY T H E C H O I C E O F T H R E E ( 3 ) C E RT I F I E D M E D I C A R E SUPPLIERS TO SELECT FROM. 5 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES T H E B E N E F I C I A RY S H O U L D A LW AY S C H E C K W I T H T H E C E RT I F I E D M E D I C A R E D M E P O S S U P P L I E R ( S ) T O M A K E C E RTA I N T H AT T H E Y A R E S T I L L C E RT I F I E D

WITH MEDICARE TO PROVIDE DMEPOS SUPPLIES OR EQUIPMENT NEEDED. 6 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES T E R M I N AT I O N O F M E D I C A R E S C O M P E T I T I V E B I D D I N G PROGRAM P L E A S E B E A D V I S E D T H AT A S O F D E C E M B E R 31, 2018, THE DMEPOS COMPETIVE BIDDING PROGRAM CONTRACTS EXPIRED AND WILL R E M A I N S O U N T I L A P P R O X I M A T E LY D E C E M B E R 31, 2020.

EF FEC T I V E , J A N UA RY 1 , 2 0 1 9 A N Y C E RT I FI E D D M E P O S S U P P L I E R M AY F U R N I S H D M E P O S S U P P L I E S O R E Q U I P M E N T. ( S E E A T T A C H E D D E TA I L E D I N F O R M AT I O N O N T H I S N E W PROCEDURE AND A LIST OF MEDICARES CERTIFIED SUPPLIERS) NOTE: INCONTINENCE SUPPLIES AND A U T O M AT I C B L O O D P R E SS U R E M O N I T O R S D O NOT NEED A DENIAL FROM MEDICARE ALL 7 CERTIFIED MEDICARE DMEPOS SUPPLIERS CAN DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES RESOURCE NOTES Y O U C A N A L S O LO C AT E A M E D I C A R E C E RT I F I E D

D M E P O S S U P P L I E R BY: U S I N G TH E M ED I C A R E S U P P L I ER D I R EC T O RY ( W W W / M E D I C A R E . G OV / S U P P L I E R ) O R BY CALLING 1-800-MEDICARE (1-800-633-4227) TO A S K A Q U E S T I O N O R F I L E A C O M P L A I N T. O N T U E S D AY S A N D W E D N E S D AY S , Y O U C A N C O N TA C T M E F O R A SS I S TA N C E AT T H E O F F I C E O F H E A LT H C A R E O M B U D S M A N A N D B I L L O F R I G H T S (OHCOBR) 202-724-4207 (DIRECT LINE) 202-724-7491 (GENERAL LINE) 8

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