How to Submit a DME Referral for an Injured Worker

For adjusters and case managers handling workers' compensation claims, DME referrals are among the most frequent — and most time-sensitive — service requests you'll submit. A well-structured referral gets equipment to the claimant faster, reduces back-and-forth, and avoids authorization delays. A poorly structured one can set the process back by days.

This guide walks through exactly what you need to submit a complete, effective DME referral.

What Information Goes in a DME Referral?

The single most common cause of DME delivery delays is incomplete referral information. To get same-day or next-day delivery on standard equipment, your referral should include:

• Patient name and date of birth — Required for all orders
• Delivery address — Home address, hospital, or facility address with unit number if applicable
• Claim number and carrier name — For billing and authorization purposes
• Adjuster/case manager name and direct contact — So your coordinator can reach you with questions
• Equipment requested — Be as specific as possible (e.g., "standard manual wheelchair" vs. just "wheelchair")
• Diagnosis and physician's order — Many carriers require a physician prescription; include the ICD-10 code and treating physician information
• Delivery timeline needed — Same-day, next-day, or standard
• Any special requirements — Weight capacity, patient height, specific features (elevating leg rest, pressure-relief cushion, etc.)

How to Categorize the Equipment

DME falls into several categories that affect how orders are processed and priced:

• Standard DME — Walkers, crutches, standard wheelchairs, bath benches, commodes, hospital beds. Typically same-day or next-day delivery from local supplier inventory.
• Complex Rehabilitation Technology (CRT) — Power wheelchairs, tilt-in-space systems, custom seating, ventilators. These require more lead time, custom configuration, and often an in-home evaluation by a certified ATP (Assistive Technology Professional).
• Respiratory — CPAPs, BiPAPs, nebulizers, oxygen concentrators. These may require respiratory therapist setup and ongoing supply orders.
• Wound Care / Negative Pressure — NPWT systems and wound care supplies. Nursing coordination is often needed alongside the equipment order.
• Orthotics and Prosthetics — Braces, supports, compression garments. May require fitting by a certified orthotist/prosthetist.

Authorization: What Needs It and What Doesn't?

Authorization requirements vary by carrier and state. However, as a general guide:

• Standard DME under $500 — Many carriers allow this to proceed without pre-authorization if there's a valid physician order on file
• CRT and power mobility devices — Almost always require prior authorization and a face-to-face evaluation
• Rental vs. purchase decisions — Short-term equipment (less than 3 months) is often rented; longer-term is purchased. Your DME coordinator can advise on the most cost-effective approach

Common DME Referral Mistakes to Avoid

• Ordering the wrong category — A standard wheelchair won't serve a claimant who needs a power chair. Discuss functional needs with the treating physician before ordering.
• Missing the delivery address — If a claimant is in a hospital or SNF, note whether you want delivery to the facility or the home (for after discharge).
• No physician order — Many carriers will deny or delay payment without a documented physician prescription. Get this before submitting.
• Not specifying urgency — If the claimant is being discharged today, say so. Your DME coordinator needs to know in order to prioritize.

How HealthCare Comp Handles Your DME Referral

When you submit a DME referral to HealthCare Comp, your dedicated Care Coordinator confirms the order details within hours, sources equipment from our accredited provider network, and arranges delivery. For standard items, same-day delivery is available in most markets. Patient instruction on proper use of the equipment is included at no additional charge.

You'll receive confirmation of delivery with documentation suitable for your claim file — no chasing required.

Submit your referral online, by email to Orders@HealthCareComp.com, or call (800) 231-9311.