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Durable Medical Equipment (DME) Provider Database

Durable Medical Equipment (DME) providers/agencies are encouraged to fill out the following form. Providing Superior with this information will help us highlight the DME supplies available to Superior HealthPlan members through your organization. Please complete the form for each TIN and NPI combination.

Please note: For any future updates on supplies offered, please resubmit this form utilizing the same TIN/NPI combination. Superior will utilize the most recent submission information.

Agency Name/DBA *

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Primary Agency Phone Number *

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Agency Website

Agency Email Address

Agency Fax Number

Agency Tax Identification Number (TIN) *

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Agency National Provider Identifier (NPI) *

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Service Delivery Area(s) Agency Provides Services required * Bexar Central Dallas El Paso Harris Hidalgo Jefferson Lubbock Northeast Nueces Travis West Texas (Statewide) Other (Outside of Texas)

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Which Durable Medical Supplies (DME) Do You Offer?
Note: DME supplies are organized by category.

Adaptive Aids

Adaptive Aids AC Units AC/Heater Combo Unit Coated Feeding Equipment Door Alarms Electric Self-feeders Food Processor Generator Geri-chair Heater Units Heating/Cooling Pads Holders Hoyer Lift Auditory Adaptations to Mobility Devices Bed Alarms Lift Installation Lift Recliners - Bariatric Lift Recliners - Standard Light-activated Devices Locks Mat Alarms Modular Ramps Motion-activated Devices Reacher/Grabber Seat Alarms Blender Ceiling Lift with Tracks Cooling Vest Shaped, Bent, Built-up Utensils Sock Puller Specialty Adapted Kitchen Appliances Stabilizing Devices Tomato Chair Trapeze Bars Vehicle Modification Voice-activated Devices Weighted Equipment Weighted Utensils Wheelchair Porch Lifts Other

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If other, please list supply:

Bath Safety

Bath Safety 3-1 Commode - Bariatric 3-1 Commode - Standard Bath Mats Bathtub Seat Lifts Grab Bars/Safety Bars Hand Held Showers Raised Toilet Seat Shower Chair - Standard Shower Chair with Back - Standard Shower Chair with Back - Bariatric Shower Chair - Bariatric Shower Chair Level 2 Shower Chair Level 3 Shower Head Shower Wand Toilet Seat Reducer Rings Transfer Bench - Standard Transfer Bench - Bariatric Other

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If other, please list supply:

Bed and Bed Accessories

Bed and Bed Accessories Air Fluidized Bed System Bariatric Beds Bed Assist Rails Billi Lights Blankets Blankets - Weighted Crib Egg Crate Mattress Pad Gel Overlay Mattresses Hospital Bed - Fully Electric - Standard Hospital Bed - Standard Hospital Bed - Bariatric - Non Electric Hospital Bed - Bariatric - Fully Electric Hospital Bed Sheets Hospital Bed Side Rails Hospital Mattresses Matresses Moisture Protective Mattress Cover Over Bed Table Pediatric Bed Semi-electric Bed Sheepskin Mattress Pad Other

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If other, please list supply:

Blood Pressure

Blood Pressure Monitor/Cuff Talking BP Monitor Other

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If other, please list supply:

Breast Pump

Breast Pump Electric Hospital-grade Pump Manual Other

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If other, please list supply:

Communication Aids

Communication Aids Alphanumeric communicators Communication device batteries Communication device repairs Direct selection communicators Encoding communicators Scanning communicators Speaker and cordless telephones Speech amplifier Speech generating device Other

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If other, please list supply:

Compression Garments

Compression Garments Compression Stockings Custom Standard Other

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If other, please list supply:

Diabetic Supplies and Equipment

Diabetic Supplies and Equipment Alcohol Prep Pads Continuous Glucose Monitoring System Hybrid Machine Insulin Pump Lancets Medtronic Insulin Pump Therapy Continuous Glucose Monitors Meter Sharps or Biohazard Containers Syringes Test Solution Test Strips Other

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If other, please list supply:

Enema

Enema Peristeen Anal Irrigation Enema Other

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If other, please list supply:

Enteral Nutrition

Enteral Nutrition Enteral Nutrition Primary Enteral Nutrition Supplemental Feeding Pump Feeding Sets Feeding Tubes Mickey Buttons Nutrition Supplement Thickener Other

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If other, please list supply:

Hearing Aids

Hearing Aids Batteries Bone Anchored Hearing Aids (BAHA) Cochlear Implants Other

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If other, please list supply:

Incontinence

Incontinence Barrier Cream Briefs Disposable Underpad (Chux) Liners Pull Ups Urinal Washable Bed Pads Wipes Other

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If other, please list supply:

International Normalized Ratio Monitor (INR)

International Normalized Ratio Monitor (INR) INR Machine INR Machine Supplies INR Monitor Other

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If other, please list supply:

Miscellaneous Supplies and Equipment

Miscellaneous Supplies and Equipment Alarm Devices Alarm Pill Box Alcohol Wipes/Pint Betadine External Defibrillator Gloves IV Supplies Medical Alert Bracelet Pedal Exerciser Pill Box Pulse Oximeter Scale Sheets Sterile Water Stethoscope Talking Pill-Box with Alarm Talking Thermometer Tens Unit Towels Wash Clothes Wigs Other

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If other, please list supply:

Mobility Aids and Accessories

Mobility Aids and Accessories 3 Wheel Scooters - Bariatric 3 Wheel Scooters - Standard 4 Wheel Scooters - Bariatric 4 Wheel Scooters - Standard Battery Chargers Cane - Blind Cane - Quad Cane - Single Point Cane - Three Point Crutches Custom Manual Wheelchair Custom Power Wheelchair Forearm Platform Attachments For Walkers and Motorized/Electric Wheelchairs Knee Walker Light Weight Wheelchair Manual Wheelchair - Bariatric Manual Wheelchair - Standard Manual Wheelchair Repair Power Wheelchair - Standard Power Wheelchair- Bariatric Power Wheelchair Batteries Power Wheelchair Repairs Prescribed Exercise Equipment and Therapy Aids Rentals Scooter Batteries Scooter Repair Sip and Puff Controls Stairway Lifts Strollers- Bariatric Strollers - Standard Walker - Bariatric Walker - Standard Walker Basket Attachment Walker Rollator - Bariatric Walker Rollator - Standard Walker Seat Attachment Walker with Seat- Bariatric Walker with Seat- Standard Walking Belt Wheelchair Cushion Other

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If other, please list supply:

Neurostimulators

Neurostimulators Neuromuscular Electrical Stimulators (NMES) Other

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If other, please list supply:

Orthopedic

Orthopedic Belt Boot Braces Splints Other

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If other, please list supply:

Orthotics

Orthotics Compression Stockings Diabetic Inserts Diabetic Shoes - Custom Diabetic Shoes - Prefabricated Diabetic Slippers Diabetic Socks Dynamic Splinting Device - Adult Dynamic Splinting Device - Infant Dynamic Splinting Device - Pediatric Dynamic Splinting Device - Youth Other

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If other, please list supply:

Ostomy

Ostomy 1-Pieces Barrier Belt Deodorant Irrigation Set Lubrication Paste/Adhesive Pouch/Bag Other

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If other, please list supply:

Personal Care

Personal Care Body Cleanser Dressing Aids Electric Razors Electric Toothbrush Mouth Swabs Perineal Wash Skin Care Toothettes Water Pick Other

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If other, please list supply:

Phototherapy

Phototherapy Bili Lights Bili Blanket Other

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If other, please list supply:

Pneumatic Compression Devices

Pneumatic Compression Devices Abdominal Binders Elbow Protectors Hand Rolls Heel Protectors Knee Protectors Standing Boards Wedge Pillow Other

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If other, please list supply:

Prosthetics

Prosthetics Breast Facial Limbs Prosthetic Eye Other

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If other, please list supply:

Respiratory

Respiratory Apnea Monitor BiPAP BiPAP/CPAP Headgear Cough Assist Devices CPAP High Frequency Chest Wall Oscillation System (Vest) Humidifier Intrapulmonary Percussive Ventilation (IPV) Machines Nebulizer Oxygen Concentrators Oxygen Monitors Portable Air Purifiers and Filters Respirators Spirometers and Peak Flow Meters Suction Pump Ventilators Other

Error: This field is required.

If other, please list supply:

Safety Devices

Safety Devices Defibrillator "Life Vest" Elbow/Knee Pads Helmets Helmets For Newborn Cranial Deformations Safety Padding Visual Alert System Other

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If other, please list supply:

Total Parental Nutrition (TPN)

Total Parental Nutrition (TPN) Total Parental Nutrition (TPN) Other

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If other, please list supply:

Trach

Trach Cannula Collar/Holder Suction Catheter Tube Cuff/Non-Cuff Other

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If other, please list supply:

Urogloical

Urogloical Barrier Catheters Drain Bag External Catheters (Purewick) Insertion Tray Irrigation Tray/Syringe Other

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If other, please list supply:

Wound Care

Wound Care Adhesive Remover Alginate Bandages Burn Compression Garments - Custom Burn Compression Garments - Presized Central Venous Catheter (CVC) Supplies Collagen Composite Dressing Contact Layer Foam Dressing Gauze Hydrocolloid Hydrogel Left Ventricular Assist Device (LVAD) Supplies Negative Pressure Wound Therapy Saline Skin Sealant Tape Wound Vac Other

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If other, please list supply:

Please identify which Medicare Advantage plans you are in network with to help us better coordinate care for STAR+PLUS members who may have some services covered under Medicare (if applicable). Amerigroup Anthem Cigna El Paso County Humana Imperial Molina Traditional UnitedHealth Group Wellcare Wellcare By Allwell Other

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If other, please list supply:

This Form Must Be Completed By An Authorized Representative Of The Agency.

Name of Person Completing Form *

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Title *

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This form will send your message to Superior HealthPlan as an email. The email is not encrypted and is not transmitted in a secured format. By communicating with Superior through email, you accept the risks associated thereof. Superior does not accept responsibility or liability for any loss or damage arising from the use of email. To ensure the safety of your protected health information (PHI), please send us a message through the Secure Member Portal or Provider Portal. If you do not want to continue with this online submission, please do not hit submit and close your browser.

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If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. You can also request any materials on this website in another format, such as large print, braille, CD or in another language. Simply call Superior Member Services.

Superior HealthPlan
5900 E. Ben White Blvd.
Austin, TX 78741

You will need Adobe Reader to open PDFs on this site.

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You will need Adobe Reader to open PDFs on this site.

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If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. You can also request any materials on this website in another format, such as large print, braille, CD or in another language. Simply call Superior Member Services.

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