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DiabeticSupplies.com

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Medicare Advantage Plans Forms

Please have your Medicare Advantage Plan card and doctor's information with you call us for the first time.

We will send your first order and bill your Medicare Advantage Plan only if the following forms are completed and returned to DiabeticSupplies.com, and after we confirm the order with you to let you know what your doctor prescribed, review your Medicare Advantage Plan benefits (as applicable), and explain our services. 

And rest assured - we will never send any order without your prior authorization.

You must have Adobe Acrobat Reader in order to view and print the forms.

1) Authorization of Billing (AOB) with first order only

2) Proof of Diabetic Education with first order only

3) Glucose Testing Log only required if you test more than the Medicare guidelines below:

If you test your blood sugar more than 3 times per day and are treated with insulin

or

If you test your blood sugar more than one time per day and not treated with insulin

Note: Medicare Advantage Plans will pay for additional testing above the Medicare guidelines.  However, we must have the above testing log on file to document your actual use and documentation from your physician that we will obtain on your behalf, such as a prescription.  

Return forms to the following:

  •  Fax toll-free to 1-866-FaxAndGo (1-866-329-2634) or (360) 723-9030

or

or

  • If you are unable to fax or email then you can mail the forms to the following address:
DiabeticSupplies.com
2210 W Main St, Suite 107-388
Battle Ground, WA  98604

The forms below do not need to be returned.   However, they are included for your understanding of the standards we comply with and what you can expect from us as your supplier of diabetic supplies.

DiabeticSupplies.com: Understanding Our Service

Notice of Privacy Practices

Medicare Supplier Standards

 

 

Frequently Asked Questions

Do I need to fill out an Authorization of Billing form?

If you have a Medicare Advantage Plan and you would like DiabeticSupplies.com to submit claims for diabetic supplies on your behalf, this form must be completed and returned before we can send your diabetic supplies.

Why does DiabeticSupplies.com require this information?

We are not allowed to submit claims to your Medicare Advantage Plan withou your explicit authorization. By completing the Authorization of Billing form, you are givingt DiabeticSupplies.com authorization to submit Medicare Advantage Plan claims on your behalf.

When do I need to send this form?

As soon as possible - we cannot send you your testing supplies without this completed form in our files. The good news is that this form only needs to be completed once.

Do I need to fill out a Glucose Testing Log?

Only if you have a Medicare Advantage Plan and if a Doctor's Order states you are testing more than the Medicare guidelines below, then you must provide DiabeticSupplies.com with a Glucose Testing Log once every 6 months:

  • more than 1 time per day while NOT being treated with insulin, or
  • more than 3 times per day while being treated with insulin

Why does DiabeticSupplies.com require this information?

Medicare Advantage Plans have stated that they will only pay for diabetic supplies that if  "reasonable and necessary." If DiabeticSupplies.com is unable to provide your Medicare Advantage Plan with this information when submitting a claim, your Medicare Advantage Plan will more than likely not pay for the diabetic supplies. Medicare may pay for diabetic supplies that exceed Medicare guidelines with a Doctor's Order and with proof of testing (Glucose Testing Log).

When do I need to send this form?

DiabeticSupplies.com requires this information once every six (6) months from Medicare Advantage Plan customers who test more than the Medicare guidelines noted above. Please return this form to DiabeticSupplies.com at least two weeks before you need your next order of diabetic supplies to allow for order processing. If you do not provide a Glucose Testing Log to DiabeticSupplies.com once every 6 months, then we will only send the lesser of your Doctor's Order or Medicare guidelines for diabetes testing supplies.

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