MB Services - DME Billing - Professional Billing that Pays.

Address:	P.O. Box 309 Poughquag, NY 12570
Phone:	845 724-5698
Fax:	845 724-4499
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MB Services
Professional DME Billing That Pays

Forms

Listed below are the most common forms that you will need to send in to us. If you have any questions on which forms you need to send in for your particular case please give us a call.

Certificates of Medical Necessity - Texas Medicaid - HCFA 1500

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Certificates of Medical Necessity
Form Number	Form Name	Type - Size
Group2 - Support Surfaces	Statement of Ordering Physician - Group 2 Support Surfaces	pdf - 1page 692 kb
DMERC 03.02	Certificate of Medical Necessity - Continuous Positive Airway Pressure (CPAP)	pdf - 1page 993 kb
DMERC 04.03B	Certificate of Medical Necessity - Lymphedema Pumps	pdf - 1page 1.02 Mb
DMERC 06.02B	Certificate of Medical Necessity - Transcutaneous Electrical Nerve Stimulator (TENS)	pdf - 1page 1.25 Mb
DMERC 09.02	Certificate of Medical Necessity - External Infusion Pump	pdf - 1page 1.16 Mb
DMERC 10.02B	Certificate of Medical Necessity - Enteral Nutrition	pdf - 1page 1.16 Mb
DMERC 11.01	Certificate of Medical Necessity - Section C Continuation Form	pdf - 1page 582 kb
DME 484.03	Certificate of Medical Necessity - Oxygen	pdf - 1page 1.41 Mb
State Medicaid Forms Provided as Needed
Form Number	Form Name	Type - Size
DME THSteps-CCP	Wheelchair Seating Evaluation Form (THSteps-CCP / Home Health)	pdf - 6pages 3.72 Mb
D.18	Home Health (Title XIX) DME/Medical Supplies Physician Order Form	pdf - 1page 1.42 Mb
D.19	Addendum to Home Health (Tite XIX) DME/Medical Supplies Physician Order Form	pdf - 1page 1.26 Mb
NHIC fsf	National Heritage Insurance Company - Functional Status Form	pdf - 1page 721 kb
NHIC lal	National Heritage Insurance Company - Low Air Loss Beds and Mattresses	pdf - 1page 565 kb
NHIC hb	National Heritage Insurance Company - Hospital Bed	pdf - 1page 655 kb
NHIC pr	National Heritage Insurance Company - Portable Ramp	pdf - 1page 741 kb
HCFA 1500
Form Number	Form Name	Type - Size
HCFA 1500	Health Insurance Claim Form	pdf - 2pages 4.89 Mb