Provider update: January 15, 2021
To: Case Management and DME Providers
Subject: DME Update (Nutritional Supplements)
Date: January 15, 2021
Incorrect information was included in the DME Changes bulletin sent 11/6/2020 regarding entry of nutritional supplements on the Member’s planned service in Harmony. We apologize for this inconvenience and have made the following changes related to nutritional supplements.
New Document in Harmony
- A new document, that will assist Case Managers (CM) with calculating units for Nutritional Supplements for a Member’s service plan, has been added to Harmony. Case Managers will complete this document and add it to the “Documents” Tab of the Member Chapter
- Four questions on this document must be answered by the CM. The information entered into these fields should come directly from the “Order for Nutritional Supplements” form obtained from the Physician and the “ADvantage Covered DME Product” list found in the library site.
- Once the four questions are answered, the last section will display the information that should be entered on the planned service line for the specific item.
- The DME Changes bulletin sent out on 11/6/2020 has been renamed “DME Information” and placed on the library site.
- The section regarding entry of nutritional supplements has been updated.
- A FAQ section has also been added and will be updated as needed.
- The “ADvantage Covered DME Product” document has also been updated.
- Authorization lines that were entered using the incorrect instructions should now be updated in the Harmony system by the MSU. If you find one that has not been updated correctly, please submit a PQ and the current authorization will be revised to show the correct number of units.
- DME Providers should be mindful that the units per frequency on the authorization is NOT the authorized number of cans/cases and IS actually the authorized number of units which is based off of 100cal = 1 unit or 500ml = 1 unit depending on the product.
Rates in Harmony
- If an item has a rate assigned by OHCA (system rate), when the item is authorized in Harmony, only the units are transmitted to OHCA. *The rate is only transmitted on manually priced items.
- On system rate items, the claim will pay at the OHCA assigned rate, regardless of the total cost listed in Harmony.
- Since rates are required fields in the Harmony system, the non-rural rate is being listed for consistency.
- On some items, a higher rate may be applied when the claim is submitted, if the Member’s address in the OHCA system is in a rural area.
Case Managers should contact the DME prior to placing an item on a Member’s plan, to ensure that the DME will be able to provide the specific product that the Member needs.
Please submit any questions regarding this information through the Provider Question chapter in Harmony.
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