Attention: DME Providers DME Claims Submission Invoice Requirements

DME services indicating “manually priced� on the DMA fee schedule require an invoice for claims processing. The exception to this requirement is wheelchairs, wheelchair accessories, Farrell valves (A9999), and services which Medicare is primary payer.

Follow the instructions below when submitting claims for manually priced services which are not an exception to the invoice requirement:

  • Services authorized prior to November 6, 2015 must include an invoice with the claim submission regardless of documentation submitted with the PA request.
  • Services authorized on or after November 6, 2015 should include the invoice with the claim submission only when the invoice was not originally submitted with the prior authorization request.
  • Manually priced services that do not require PA should always include an invoice with the claim submission.

Invoices can be uploaded through the portal and attached to the claim.

Claims which previously denied for invoice requirements may be resubmitted for processing following the above guidelines.