Continental Medical – Premium Medical Supplies & Equipment

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

Secure electronic submission below

Complete the HIPAA-compliant 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. For initial referrals containing PHI, use fax or the secure online form to ensure HIPAA compliance.

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 your MAC already issued a PA decision, include the PA number. If PA is needed but not yet obtained, we will submit the PA request on your behalf.

Height / Weight (for sizing)

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

Secure Online Submission

Submit a Referral Online

HIPAA-compliant form. Our intake team will contact you within 1 business day.

HIPAA Data Handling Notice: This form collects PHI including patient name, DOB, diagnosis codes, and insurance information. 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. A Business Associate Agreement (BAA) is available upon request — contact us at (931) 444-3335 before submitting if your organization requires one.

Out-of-State Referrals Welcome

We accept referrals for patients in 26 states where our DMEPOS product categories — ambulatory aids, bath safety, manual wheelchairs, prefabricated orthotics, TENS units, and diabetic supplies — operate without requiring a separate state DME supplier license. Please confirm your patient's state before submitting.

View all eligible states →

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 other HIPAA-compliant method 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.

Insurance Verification & PA

1–5 Business Days

We verify patient insurance eligibility, submit any required Prior Authorization, and notify you and the patient of the PA decision. (Skipped for cash-pay referrals.)

Patient Contact & Delivery Scheduling

After PA Approval

We contact the patient to confirm address, preferred delivery window, and any access requirements. Typically next business day for in-stock items once PA is approved.

Delivery & Setup

At Delivery

Equipment is delivered with instructions on safe use. Patient signs a Proof of Delivery form per Medicare Supplier Standard 12. Copy available to your office upon request.

Follow-Up to Your Office

After Delivery

We notify your office upon delivery completion. For Medicare-covered items, we provide the claim number. 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