Download EZ-DME Information
Download EZ-DME Services Information
- About EZ-DME (PDF, 1091 kb)
Obtain Service Agreements and Enrollment Forms
All required service agreements and forms are available upon request. Please contact EZ-DME Product Support:
- Email:
- If you cannot use the above link, call 888.273.0033 toll-free or fax your request to 817.413.9908.
Enrollment Packet Contents
- Instructions for getting started with EZ-DME
- EZ-DME Service Agreement
- HIPAA Business Associate Addendum Agreement
- DMERC EDI Enrollment forms, one for each of the four DMERC Regions
- If you plan to submit DME claims to State Medicaid programs, one form for each state is requested.
Return Completed Forms
After completing all the forms, please return them to EZ-DME by US 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 |
| FAX | Forms may be faxed to 817.413.9908. |
Questions? Contact EZ-DME for More Information
| Telephone | 888.273.0033
... toll-free 817.413.9908 ... fax 817.531.8992 ... office |
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