Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with PGBA, LLC before sending sensitive documents. FaxFlow is not affiliated with this organization.
PGBA, LLC fax number
(877) 989-0030
TRICARE DME CMN Forms
Used for: Submitting a TRICARE durable medical equipment (DME) certificate of medical necessity (CMN) and prescription for a claim; submission via mail or fax to PGBA.
Fax destination details
- Department
- TRICARE DME CMN Forms
- Purpose
- Submitting a TRICARE durable medical equipment (DME) certificate of medical necessity (CMN) and prescription for a claim; submission via mail or fax to PGBA.
- Form
- TRICARE DME CMN Form — Certificate of Medical Necessity (CMN) for Durable Medical Equipment (DME)
- Address
- 160 Dozier Blvd., Florence, South Carolina 29501
- Voice phone
- 843-665-7822
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Submit the CMN form with the patient's DME prescription; use one form per claim; include sponsor/beneficiary information; fax to 877-989-0030 or mail per TRICARE/PGBA instructions.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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