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If you are an Individual or Family Member, please register here.

If you are a Medicare Advantage or Medicare Supplement member, please register here.

Contracting Durable Medical Equipment

  1. Contact your Provider Relations Representative to order your contract. (See PAP100)
  2. Submit the following items. Any missing items may result in the return of incomplete documents or a delay in processing.
    • Evidence of accreditation:  DME/Prosthetic Orthotic - Medicare Accreditation/Certification through one of the CMS deemed accreditation organizations (attach a copy)
    • Surety Bond or evidence of exemption (attach a copy)
    • Malpractice/liability insurance - minimum amounts of $1 million per occurrence, $3 million aggregate (attach a copy)
    • Medicare supplier, PTAN or Legacy (DMERC) number (attach a copy)
    • Current DME, Limited Service or Community Pharmacy licensure where required (attach a copy)
    • Provider information sheet 
    • W-9
    • Exhibit 1
    • Provider tax ID or ownership update (This is only required when a new contract on an existing provider is required due to a tax ID or ownership updated.)



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Fax:  208-387-6818