Submission of Letter of Medical Necessity

This allows submission of online Medical Necessity Form for DME Prescription Requests. A durable medical equipment company shall be contacting you and your patient within one business day to acknowledge receipt and make sure all the necessary information has been provided. You'll need a user account to access this portal and submit the request. To request access, please select the "Contact Us" button and provide the requested information. This portal is designed, operated and maintained to comply with HIPAA requirements.

By entering this site, you are agreeing to you are a currently authorized user of an individual, practice or any other entity that is allowed by law to submit a Letter of Medical Necessity.

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