How To Enroll with EZ-DME
Introduction
Our customers use EZ-DME to submit Durable Medical Equipment (DME) claims to Medicare, State Medicaids, and/or private pay/third party programs.
General Information
The sections on this page tell you which forms you need to obtain, print, complete, and submit to FDS EZ-DME so that you may submit Medicare, State Medicaid, or private pay/third party DME claims. Please read this entire page to ensure the successful completion and submission of your enrollment documents.
Requirements
Medicare Provider Number
- EZ-DME customers must have a Medicare Provider Number in order to submit claims to Medicare.
- If you do not have a Medicare Provider Number, you can apply for one by calling the National Supplier Clearinghouse at 866.238.9652.
National Provider Identification Number (NPI)
- EZ-DME customers must have an NPI Number in order to submit claims to Medicare.
- If you do not have an NPI Number, you can apply for one. For more information, visit the NPI Number Resources page on EZ-DME's sister site, FDS.
DME MACs Registration
- Registration with all four DME Medicare Administrative Contractors (DME MACs). See this page for DME MACs contact information.
Registration with desired State Medicaid Programs
- Call the EZ-DME team at 888.273.0033 for state-specific contact information.
FDS Service Agreement and Enrollment Forms Packet
The Enrollment Packet consists of:
- Instructions for getting started with EZ-DME
- EZ-DME Service Agreement
- HIPAA Business Associate Addendum Agreement
- DME Medicare Administrative Contractors (DME MACs) EDI Enrollment forms, one for each of the four DME MAC Regions
- If you plan to submit DME claims to State Medicaid programs, one form for each state requested
All required documents and forms are available upon request. Please contact EZ-DME Product Support:
| Mailing Address |
FDS EZ-DME 2601 Scott Avenue, Suite 600 Fort Worth, TX USA 76103 |
| Telephone | 888.273.0033 ... toll-free 817.413.9908 ... fax 817.531.8992 ... office |
Important - Original signatures are required on all forms. After completing the forms, please return them to FDS EZ-DME by U.S. Postal Service or other carriers such as FedEx or UPS. Please send forms to:
| Mailing Address |
FDS EZ-DME 2601 Scott Avenue, Suite 600 Fort Worth, TX USA 76103 |
