DME Benefit Limits Verification Request Form

February 3, 2021

Effective Feb. 1, 2021, providers who provide Durable Medical Equipment (DME) services to our Blue Cross Community Health PlansSM (BCCHPSM) and/or Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members, will have the ability to verify DME Benefit Limits information by completing the DME Benefit Limits Verification Request Form.

Complete this form in its entirety to ensure accurate and timely processing and email to BCCHP Benefit Limit Verification. Providers will receive the requested benefit limit verification information within two business days.

If you have any questions, contact your Provider Network Consultant (PNC) at
855-653-8126 or Government Providers.