Payer Names and IDs
Order Pro Error Messages
Who can sign the document?
Docs Docs Docs
Allowables
100

Virginia Medicaid

Payer ID 1 and 8

100

Physician's order expired for T4535 on 06/05/2025

What is No Valid ppwk on file


Actions taken: Confirm what is needed with the customer and request paperwork.

100

Medicare

Doctor of medicine / Doctor of osteopathy (including osteopathic practitioner) - must be licensed to practice medicine and surgery / Doctor of dental surgery or dental medicine / Doctor of podiatry / Doctor of optometry / Physician assistant / Nurse Practitioner / Clinical Nurse Specialist

100

LOMN 

What is Letter of Medical Necessity? Document that must be typed on a doctor's letter explaining the need for an overage or combination of HCPCs usually not shipped together. Usually needed before requesting a PAR

100

Payer : Virginia Medicaid

HCPCs: T4525, T4535

T4525 - 180

T4535 - 180


200

Bluecross Blue Shield of Tennessee

1700


200

Physician's Order on file but not returned for T4524 with effective date: 07/02/2025

What is we have requested ppwk but it has not been returned by the doctor.

Action taken: Check Medidoc to see if doc has been returned, since last Medidoc note. If yes send to MDA to review, If no send to Doc team

200

Virginia Medicaid

Physician (MD) / Doctor of osteopathic medicine (DO) / Nurse practitioner (NP) / Physician assistant (PA)

200

MED RECS

What are MEDICAL RECORDS (Chart notes) - 

These are chart notes from the patients last office visit. They contain information pertaining to the customer condition, and are used by the plan to determine, usage and need. Sometime needed before a PAR, sometimes needed on their own.

200

Payer: Horizon NJ Health

HCPCs: T4525, T4543

T4525 - 300

T4543 - 300



300

Medicare

13,225,226,230,1782,2237

300

Prior Authorization not on file for T4530

We have not requested a PAR, and quantities indicate one is needed.

Actions taken: Check payer reqs. Do all HCPCs for this payer require a PAR. If yes, confirm items and quantities, and request a new PAR and new LOMN/MED RECS, if payer requires. If no, ship the allowable and request a new PAR and new LOMN/MED RECS, if payer requires

300

Blue Cross Blue Shield of Tennessee

ยท  Physician (MD) / Doctor of osteopathic medicine (DO) / Nurse practitioner (NP) / Physician assistant (PA)

300

PO

Physician's Order - prescribing document

a medical professional's written or verbal instructions for a patient's care, treatment, or management.

Kind of a nationwide document, used for supplies covered by Medicare and some state level payers

300

Payer: Horizon NJ Health

HCPCs: T4525, T4535, A4554

T4525 + T4535 - 300

A4554 - 300

400

508

CareSource OH MCO

400

CMF7-BG20 is discontinued

Hover over the line item and look in "Comments" for alternate SKU or product team notes, inform the customer, update the order and save to the template

400

Horizon NJ Health

Physician (MD, DO, DPM, etc.) / Physician assistant / Nurse Practitioner 

400

CMN 

Certificate of Medical Necessity / (Also includes TITLE XIXs for Tx) prescribing docs.

an official document from a physician or other healthcare provider, stating that a patient needs specific medical equipment, supplies, or services due to a diagnosed medical condition 

Each state has its own specific requirements for what information needs to be included on a CMN.

400

Payer: Tennessee Medicaid

HCPCs: A4335, T4541, T4524, T4535, A6250

No allowables. HCD is enrolled with Tennessee Medicaid. However, Tennessee Medicaid covers DMEPOS through Managed Care plans only. HCD is contracted with the following Managed Medicaid plans in Tennessee: 

  • BCBS TN BlueCare (1700)
  • BCBS TN TennCare Select (1701)
  • Wellpoint (Amerigroup) TN Medicaid (2051)
500

2165

Horizon NJ Health

500

CRD701-BG20 is not covered

1. The item is not covered by the plan.    or

2. The Insurance is missing or incorrect on the order

3. Not tied to the correct payer

If 1., Advise the customer, remove the item and continue with the order

If 2., Document the customer insurance information and assign the order to verification to add and check the insurance. Advise customer to call back in 24-48 hours 

If 3., reach to Cat Mgmt to correct

500

Humana Kentucky

Physician (MD) / Podiatrist / Optometrist / Dentist / Advanced Practice Registered Nurse (APRN) / Physician assistant (PA) / Chiropractor

500

PAR

Prior Authorization Request - (comes from the insurance) 

a process where a health plan needs to approve a medical service or prescription before it's covered. This can be triggered by going over the allowable or exceeding a specific dollar amount. In some instances a plan may require a Prior Auth for all items regardless of quantity

500

Payer : Virginia Medicaid

HCPCs: T4525, T4535, T4541, A4927, E0325

Either

T4525 -180 / T4535 -180 / A4927 -2 / E0325 -1

or

T4541 - 180 / A4927 -2 / E0325 -1 

( # Denotes T4541 and T4542 are not covered in conjunction with any absorbent product.)