Tag: #dme

Posted in #Medicareadvantage, #reimbursement, #unitedhealthcare, Payer Updates, Prior Authorization Insurance Carrier Updates

UHC Medicare Advantage Plans: DME changes in certain States

Posted on by KR2Medical Billing

For any DOS April 1st 2026 and thereafter the new company that will manage DME ordering and fulfillment will be Synergy Health.

This change will apply to Medicare Advantage Plans in certain states:

Individual HMO and PPO plans:

Via UHC website

Chronic Special Needs Plans (C-SNP)

Via UHC website

Dual Special Needs Plans (D-SNP):

  • North Dakota
  • South Dakota
  • West Virginia

DME providers would need to join Synapse Health network. Synapse will contact you, however you can also reach out to them via email: JoinOurNetwork@synapsehealth.com

To which DMEs does this change apply?

  • Diabetic supplies
  • Enteral
  • Home ambulatory
  • Hospital beds
  • Insulin therapy
  • Mobility aids 
  • Negative pressure wound therapy
  • Ostomy
  • Oxygen
  • Respiratory
  • Respiratory vest
  • Sleep
  • Urological
  • Ventilators
  • Wheelchairs

The DMEs that this change does not apply to?

  • Bone growth stimulators
  • Cancer treatment
  • Cardiac defibrillators
  • Complex rehab
  • Optune device
  • Oral devices
  • Orthotics
  • Parenteral nutrition, vision, and hearing
  • Prosthetics

Authorizations:

Providers would need to request an auth from Synapse Health for DOS of April 1st 2026 and there after, via their portal https://connect.synapsehealth.com/authorization/login

As a provider you can also go on their web to request a personalized training http://www.synapsehealth.com/welcome

Which plans are no affected by this change? Medicare Advantage-

Institutional Special Needs Plans (I-SNP)
Institutional Equivalent Special Needs Plans (IE-SNPs) 
Group retiree plans

Find this type of content useful? Follow my blog for more payer updates: medical coding, billing, reimbursement, prior auth.

Posted in #reimbursement, EmblemHealth NY, Payer Updates, Prior Authorization Insurance Carrier Updates, Training

Emblem Health to add more DME codes to prior auth list.

Posted on by KR2Medical Billing

Are you a a DME provider or a physician that prescribes DME for Emblem Health members? Then this blog post is for you!

Starting on for any DOS 13,2026 and thereafter the following DME codes will be added to the prior authorization list.

Image via Emblem Health
Images via Emblem Health website

If you find this type of content useful? Follow my blog for more!

Posted in MVP (NY/VT) Insurance Payer, NY Providers, Training, Updates

MVP NY Medicaid Plans: Medical Devices and Supplies coverage change

Posted on by KR2Medical Billing

This policy applies to MVP NY Medicaid Plans and their coverage for Medical Devices and Supplies.

The following examples are not all inclusive, that apply to this policy:

  1. Foot Care products: insoles, massagers, arch supports
  2. Pill Splitters
  3. Body weight scales
  4. Pulse Oximeters
  5. Thermometer’s (only oral, rectal and basal are covered)
  6. Wheelchair products
  7. Medical fridges
  8. Commodes
  9. Transfer benches
  10. Safety rails (bed, wall, bath)
  11. Fetal dopplers
  12. Bath/shower/toilet sears
  13. Sharp’s containers
  14. Ear Plugs
  15. Nasal dilator strips
  16. Cushions
  17. Decompression belts
  18. Reaches
  19. Travel Coolers etc
Picture Via Cumberland ME

MVP is aligning with NY Medicaid Fee for Services DME coverage. Devices or supplies that are NOT COVERED under FFS Medicaid “Pharmacy Fee Schedule” will continue to not be covered. Applicable DME Products should be billed under the member’s DME Benefit.

For complete list of NY MEDICAID DME COVERED and NON-COVERED Products, please click here.

Find this type of content helpful? Follow my blog for more medical billing and coding guidelines, reimbursement/medical policy updates and any other healthcare field related news.

Recent Blog Posts: