New Durable Medical Equipment Benefit Management
Posted on May 9, 2018
Effective July 1, 2018, Health New England will partner with Northwood, Inc., to manage durable medical equipment, prosthetic, orthotic and medical supply (DMEPOS) for all members.
Under this new relationship, Northwood will manage a full range of services in order to administer our DMEPOS benefit, including:
• Prior authorization of DMEPOS
• Claims processing and adjudication
• Member and provider services related to DMEPOS requests
• Data reporting
• Provider contracting, credentialing and management
• Provider inquiries, grievances and appeals
Examples of equipment and supplies that Northwood will manage include wheelchairs, oxygen and other kinds of respiratory equipment, nebulizers, prosthetics, orthotics, wigs, speech devices and other medical supplies (diabetic, ostomy, urological, incontinence and wound care). Some equipment and supplies will still be managed by Health New England.
Please note that Health New England members’ plan benefits (as described in the Covered Services list in members’ plan materials) stay the same, except all DMEPOS through Northwood will require a prior authorization, effective July 1, 2018.
It is still the health care provider’s responsibility to prescribe, get authorization and make any other necessary arrangements with Northwood or Health New England for medically necessary equipment and supplies.
As we transition, more communications about this new relationship will be available on hnetalk.com/provider, and on our website at healthnewengland.org/Providers/Resources. In the meantime, continue to follow all procedures described in our Provider Manual at healthnewengland.org/provider-manual.
