Provider Referrals & DMEPOS OrderingSubmit DME and supply referrals by phone, fax, or secure online form.

Provider Direct Line:(931) 444-3335Mon–Fri 9:30 AM – 3:30 PM CT|FAX: (931) 225-4944|After-hours: (931) 997-3338

Referral Process

How to Submit a Referral

Four ways to refer — choose what works best for your workflow.

Fax

Fastest for documentation-heavy referrals

Fax to (931) 225-4944. Include signed physician order, patient demographics, insurance info, and clinical notes. Mark urgent referrals "STAT" on the cover sheet.

Phone

Best for complex or urgent cases

Call (931) 444-3335, Mon–Fri 9:30 AM – 3:30 PM CT. After-hours urgent: call or text (931) 997-3338. Have patient information, diagnosis, and requested equipment ready.

Online Form

Electronic submission below

Complete the referral form below. Our intake team will contact you within 1 business day to confirm receipt and request any missing documentation.

Email (follow-up only)

Not recommended for initial PHI submissions

Use email for follow-up only. Follow your organization's approved process when submitting referrals containing protected health information.

Documentation Checklist

Required Documentation

Please ensure the following documents are available when submitting a referral to avoid processing delays.

Signed Physician Order / Script

Must include patient name, DOB, equipment ordered, ICD-10 diagnosis code, length of need, prescribing provider NPI, and signature. Must be dated within the past 12 months.

ICD-10 Diagnosis Code

Specific code(s) supporting medical necessity. Must meet Medicare LCD criteria if billing Medicare. Include full code and description.

Patient Demographics

Patient name, date of birth, address, phone number, and emergency contact for delivery and billing.

Insurance / Medicare Card

Front and back of Medicare card, Medicaid ID, or commercial insurance card. Include group number and member ID.

Face-to-Face Documentation

Required for K0003–K0004 wheelchairs and some beds. Written order from the physician who performed the face-to-face exam within 6 months.

Clinical Notes (if required)

Recent office visit notes, PT/OT evaluations, or hospital records supporting medical necessity. Recommended for all Medicare referrals to expedite review.

Prior Authorization (if issued)

If the payer already issued a prior-authorization decision, include its reference number. Contact us to confirm documentation and submission responsibilities for the specific plan.

Height / Weight (for sizing)

Required for wheelchairs, orthotics, and some beds. Inaccurate sizing causes delivery delays.

Secure Online Submission

Submit a Referral Online

Electronic referral form. Our intake team will contact you within 1 business day.

Data Handling Notice: This form collects health and insurance information including patient name, DOB, diagnosis codes, and member identifiers. By submitting, you certify that you are an authorized healthcare provider or staff member submitting a referral on the patient's behalf, that you have obtained required patient authorizations, and that the information will be used only for DMEPOS referral processing. Contact us at (931) 444-3335 before submitting if your organization requires a specific agreement or transmission method.

Out-of-State Referrals Require Verification

Contact our team with the patient's destination, payer, and requested product before submitting. Availability and supplier requirements vary by state, plan, and product.

Review shipping verification details →

Referring Provider Information

Provider / Physician Name *

Prescribing Provider NPI *

Practice / Organization *

Practice NPI (Group)

Provider Phone *

Provider Fax (for sending order back)

Provider Email *

State Where Patient Resides *

Patient Information

Patient Full Name *

Date of Birth *

Patient Address *

Patient Phone *

Patient Height (wheelchairs/orthotics)

Patient Weight (weight-bearing items)

Medicare / Insurance ID

Clinical Information

Primary Diagnosis / ICD-10 Code *

Secondary Diagnosis (if applicable)

Equipment / Supplies Requested *

Length of Need

Urgency

Face-to-Face Exam Completed?

Prior Authorization Status

Primary Insurance / Payor

Signed Physician Order Ready?

Special Instructions / Additional Notes

I am an authorized healthcare provider or staff member. I certify the accuracy of this referral, acknowledge the HIPAA data handling notice above, and understand that this PHI will be used solely to process this DMEPOS order. HIPAA Notice

I confirm that a signed physician order for this equipment is available and will be submitted by fax to (931) 225-4944 or by another transmission method approved by my organization within 24 hours. (Not required for cash/private pay referrals.)

or call (931) 444-3335 · fax (931) 225-4944

After Submission

What Happens Next

Intake Confirmation

Within 1 Business Day

Our intake team calls or emails to confirm receipt, identify any missing documentation, and assign a referral tracking number.

Plan and Documentation Review

After Intake

We review the submitted plan information, identify available participation and authorization requirements, and confirm the next step with the referring office.

Patient Contact & Delivery Scheduling

After Requirements Are Confirmed

For accepted orders, we contact the patient to confirm address, delivery options, and any access requirements.

Delivery & Product Information

At Delivery

The customer receives the product and available manufacturer or supplier instructions. Required delivery documentation depends on the order.

Follow-Up to Your Office

After Delivery

We provide available order-status documentation to the referring office. Follow-up calls are welcome anytime at (931) 444-3335.

Fax Cover Sheet

Print and include with all faxed referral packages.

Continental Exquisites LLC

d/b/a Continental Medical Cleaning & Supplies

670 Horace Crow Drive, Suite E · Clarksville, TN 37043

FAX TO: (931) 225-4944

PHONE: (931) 444-3335

AFTER-HOURS: (931) 997-3338

EMAIL: info@continentalmedical.net

STATUrgentRoutine

PATIENT NAME:

EQUIPMENT REQUESTED:

INSURANCE / PAYOR:

HIPAA CONFIDENTIALITY NOTICE: This fax contains protected health information. If received in error, please destroy immediately and notify us at (931) 444-3335.

Please include with this cover sheet:

Signed physician order
Patient demographics
Insurance information
Clinical notes (if available)
Face-to-face documentation (if required)
Prior authorization (if issued)

Questions before you refer?

Our provider support team is available Mon–Fri, 9:30 AM – 3:30 PM CT. After hours, call or text (931) 997-3338.

Billing & Insurance Contact Us