Medicare AdvantageAdministrativeHigh impact
PAP289 - Providers Dispensing Prescription Durable Medical Equipment (DME) Supplies - Clarified provider participation requirements, reimbursement eligibility, compliance requirements, exceptions, and references.
Blue Cross of Idaho·ID · Sleep Medicine, Pulmonology, General Practice +2 more·Reimbursement
We identified it
Sep 1, 2026
Summary
Blue Cross of Idaho clarified DME supplier participation requirements for physicians and non-physician practitioners dispensing prescription DME supplies. Providers must now obtain CMS accreditation, Medicare DME supplier registration, malpractice insurance ($1M/$3M), a $50K surety bond, and Idaho State Board of Pharmacy registration to be eligible for reimbursement. This policy revision reinforces compliance with federal regulations and clarifies what constitutes prescription versus non-prescription DME.
Action Required
IMMEDIATE: All providers currently dispensing prescription DME supplies must verify they meet ALL five requirements: (1) CMS accreditation or CMS-approved accreditation, (2) Medicare DME supplier registration, (3) malpractice insurance minimum $1M per occurrence/$3M aggregate, (4) $50K surety bond, (5) Idaho State Board of Pharmacy registration for DME. Billing team must audit credentialing files and contact providers to confirm compliance. Update provider enrollment checklists and contracting templates to require evidence of all five credentials before approving DME reimbursement. Do not process DME supply claims from providers lacking documented compliance with these requirements—claims will be denied. Flag any existing contracted DME suppliers missing credentials for immediate remediation. Providers must also comply with 42 C.F.R. § 424.57 DMEPOS quality standards. Document all compliance verification in provider files.