TR593Molina Healthcare, Inc., Durable Medical Equipment DME Presentation

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Title: TR593Molina Healthcare, Inc., Durable Medical Equipment DME Presentation

1
DME
October 2005
2
Agenda

3
DME Policy

All DME must be ordered in writing by a physician
4
DME Policy

DME Policy
Package C
For Package C members, medical supplies and
equipment, including prosthetic devices, implants
and hearing aids are covered when medically
necessary
DME for these members is limited to
2,000.00/year or 5,000.00/lifetime (not
including eyeglasses)
Equipment may be leased or purchased depending on
which option is more cost-efficient

5
DME Policy

DME Policy
Rent vs. Purchase
Molina is following the existing IHCP policy in
regard to the rental or purchase of DME items
The decision to rent or purchase DME is based on
the least expensive option for the anticipated
period of need

6
DME Policy

DME Policy
Continuity of Care
Service or item authorizations issued by Health
Care Excel (HCE) for members in the PCCM program
will be honored for thirty (30) days
Service or item authorizations issued by other
MCOs for members now enrolled with Molina
Healthcare will be honored for thirty (30 days)

Copies of the previously issued authorizations
will be required
7
Prior Authorization

Prior Authorization
Beginning 1/1/05, all DME items with a line item
cost of over 200.00 had required PA
Effective 11/1/05, line item cost will no longer
determine what items require authorization

A complete list of the HCPCS codes requiring
Prior Authorization will be available
at www.molinahealthcare.com
8
Prior Authorization

9
Prior Authorization

Prior Authorization (contd)
PA/Service Requests
Requests must be submitted on the Molina Service
Request Form
Each form must be completed in its entirety
including
the appropriate HCPCS codes
clinical documentation to support the need for
the requested equipment or supplies
Requests may be mailed to Molina at the address
of the form or faxed to our office at
219-736-8771

10
Home Medical Equipment Providers

Effective August 1, 2006 must be licensed by
Indiana State Board of Pharmacy.
Providers must update IHCP profiles with IHCP
Provide copy of license to EDS Provider
Enrollment
Obtain HME Provider Specialty 251
Current DME Providers enrolled as DME Provider
Specialty 250
Must bill using HME Provider Code Set
May submit claims for both HME and non-HME
supplies providers if enrolled as provider
specialty 250 251

11
Claims

Claims
The claim completion requirements for Molina
Healthcare are the same as those for the IHCP.
Detailed information regarding claim completion
may be found in the IHCP Provider Manual, Chapter
8, pages 8 150 through 8-174
Claims may be submitted electronically via WebMD
or,
by mail to

Molina Healthcare of Indiana P.O. Box 22717 Long
Beach, CA. 90801
12
The Molina Mission