How to Fill Out and Submit the Norco Medical Supply Order Form

The Norco Medical Supply order form is a two-part document: you complete the patient and insurance section, and your treating physician completes the clinical section, signs it, and dates it. You can pick up a blank form at any Norco branch or request one through the contact page at norcomedical.com/contact-us.¹ Getting it processed the first time depends almost entirely on what you have ready before you start writing.

Gather These Items First

Have the following in front of you before you fill in a single field:

Your full legal name as it appears on government records, date of birth, current mailing address, and a daytime phone number.
Your primary and, if applicable, secondary insurance cards. Copy the policy number and member ID exactly as printed. If you have Medicare, the Medicare Beneficiary Identifier (MBI) is the number the form needs.
Your treating physician’s full name and 10-digit National Provider Identifier (NPI). The doctor’s office can give you the NPI, or you can look it up in the NPI Registry at npiregistry.cms.hhs.gov.²
The ICD-10-CM diagnosis codes supporting your medical need. Your physician supplies these, not you, but knowing they belong on the form helps you follow up if the clinical section comes back blank.³

Check every insurance number against the physical card, not against what you remember from last time. Carriers reissue cards with updated numbers more often than patients realize, and a single mismatched digit will trigger a verification delay.

What Your Physician Must Provide

The clinical portion of the form is where most orders live or die. Medicare sets standardized rules that apply regardless of who the supplier is.

The Face-to-Face Encounter

For many types of durable medical equipment, Medicare requires a face-to-face visit with your treating physician within the six months before the order is written. Without it, Medicare will not pay for the equipment. As of April 13, 2026, 83 specific items appear on the CMS Required Face-to-Face Encounter and Written Order Prior to Delivery List, including oxygen delivery systems and power mobility devices. The visit can happen through telehealth if it meets CMS telehealth requirements.⁴ If you already have a recent office visit on file that addressed the condition driving the order, ask your doctor whether it qualifies. A second appointment may not be needed.

Required Elements of the Written Order

Every DMEPOS written order must contain each of these elements:

Your name or MBI
A clear description of the item being ordered
Quantity, if applicable
The treating practitioner’s name or NPI
The date of the order
The treating practitioner’s signature⁴

Signature problems are one of the fastest ways to get a claim denied. Medicare reviewers check that documentation is signed and dated, and if the signature is illegible the provider must keep a signature log or attestation linking the mark to a printed name.⁵ Stamped signatures are generally not accepted.⁶

Extra Documentation for Specific Equipment

Some equipment categories need more than the standard written order:

Oxygen: Qualifying blood gas studies must be on file, and recertification is required at set intervals. The CMS-484 Certificate of Medical Necessity has historically been used for oxygen orders, and the treating physician must review and sign the clinical sections even if a staff member fills them in.⁷
Power wheelchairs and scooters: Require a face-to-face encounter, a written order prior to delivery, and prior authorization in most cases.
Hospital beds and pressure-relief mattresses: Need documentation of qualifying medical conditions, often including a physician’s narrative explaining why standard alternatives are not sufficient.
CPAP and respiratory therapy equipment: Requires sleep study results and a physician attestation of diagnosis, with polysomnography records and AHI scores on file.

Filling In the Form

The form typically splits into two zones. The upper section holds patient-provided information; the lower section holds clinical data.

You handle the top. Fill in the biographical and insurance fields with the details you gathered, and verify every number against the card in your hand. Your physician handles the lower sections: equipment type, diagnosis codes, duration of medical need, and signature.

If you are picking up a blank form to bring to your doctor, flag the signature block before you hand it over. An otherwise complete form sitting in a doctor’s outbox waiting for a signature is one of the most common bottlenecks in the whole process, and one of the most preventable.

Submitting the Completed Form

Norco accepts orders through several channels. Which one to use depends partly on whether this is a first-time order or a resupply.

In person at a branch. Hand-delivering the form gives you immediate confirmation that staff received it and a chance to catch missing fields on the spot. Use the location finder at norcomedical.com/locations to find your nearest branch.¹
Online resupply form. If you already have established equipment through Norco and need replacement supplies on the schedule your insurance allows, use the resupply request form at norcomedical.com/Resupply. This channel is built for recurring orders, not for initial equipment setups.
Fax or direct contact. Many Norco branches accept faxed orders. Call your local branch to confirm the correct number, because respiratory equipment and general medical supplies sometimes route to different lines. The general contact form at norcomedical.com/contact-us can also point you to the right submission path.

Whichever route you choose, keep a copy of the completed, signed form. If an insurance question comes up weeks later, having your own copy saves time compared to requesting one back from the supplier.

What Happens After You Submit

Once Norco receives the form, staff run an internal verification: checking insurance eligibility, confirming the diagnosis codes match what the payer requires, and making sure the physician’s signature and NPI are present and valid. Expect a confirmation call once verification wraps up to schedule delivery or arrange a branch pickup.

Prior Authorization

Some equipment categories require prior authorization from Medicare before the supplier can deliver anything. CMS maintains a Required Prior Authorization List of specific HCPCS codes, and a January 2026 update added seven new codes covering certain orthoses and pneumatic compression devices. Those new codes become a condition of payment nationwide on April 13, 2026.⁸ Prior authorization can add several weeks, because the supplier must submit clinical documentation to Medicare and receive approval before delivering the item.

Rental or Purchase

Not all DME is sold outright. Medicare classifies equipment into payment categories, and some items are rented on a capped schedule that transfers ownership to you after 13 months of continuous rental. Simpler equipment such as canes, walkers, crutches, commode chairs, and home blood glucose monitors usually gives you a choice between renting and purchasing at the outset.⁹ Ask Norco which category your item falls into before delivery so the first bill does not surprise you.

Your Out-of-Pocket Costs

With Original Medicare (Part B), you pay 20 percent of the Medicare-approved amount for DME after meeting your annual deductible.¹⁰ The 2026 Part B annual deductible is $283.¹¹ If you have a Medicare Supplement (Medigap) or Medicare Advantage plan, your share may differ; check with the plan before the equipment ships.

The Advance Beneficiary Notice

If Norco expects Medicare to deny payment for a particular item, they are required to give you an Advance Beneficiary Notice of Noncoverage (ABN) on Form CMS-R-131 before delivering it.¹² The ABN warns you that you may be personally responsible for the full cost and gives you three choices: accept the item and agree to pay if Medicare denies it, accept the item and ask Medicare for a formal decision you can appeal, or decline the item.

Watch for the form. If a supplier delivers equipment that Medicare later denies and no ABN was provided beforehand, the supplier, not you, bears the financial liability.¹³ A new version of the ABN form took effect in March 2026, and providers must transition to it by May 12, 2026.¹²

If Medicare Denies the Order

You have the right to appeal a Medicare DME denial. The first level is a redetermination filed with the Medicare contractor that processed the claim; you have 120 days from the date you receive the denial notice to submit the request, and CMS presumes you received the notice five calendar days after it was dated.¹⁴ Most DME denials that succeed on appeal do so at the first or second level, often because additional clinical documentation was submitted that was not included with the original order. If your claim was denied for insufficient medical necessity, ask your physician for a detailed letter explaining why the equipment is needed and attach it to the redetermination request.

1
Norco Inc. Medical. Norco Inc. Medical
2
Centers for Medicare & Medicaid Services. National Provider Identifier Standard
3
Centers for Disease Control and Prevention. ICD-10-CM – Classification of Diseases, Functioning, and Disability
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Centers for Medicare & Medicaid Services. Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Order and Face-to-Face Encounter Requirements
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Centers for Medicare & Medicaid Services. Complying with Medicare Signature Requirements
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Noridian Healthcare Solutions. Medical Documentation Signature Requirements
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Centers for Medicare & Medicaid Services. Certificate of Medical Necessity – Oxygen
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Centers for Medicare & Medicaid Services. Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
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Noridian Medicare. Capped Rental Items
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Medicare.gov. Durable Medical Equipment (DME) Coverage
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Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
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Centers for Medicare & Medicaid Services. FFS ABN
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Centers for Medicare & Medicaid Services (CMS). Advance Beneficiary Notice of Non-coverage Tutorial
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Centers for Medicare & Medicaid Services. First Level of Appeal – Redetermination by a Medicare Contractor