Provider update: February 3, 2021

To:  Case Management and DME Providers

Subject: Installed DME Items

Date:  February 3, 2021

Effective immediately all DME items that require installation in the Member’s home will be added to the ADvantage service plan using service code S5165:TF (Home Modifications, Per Service).

S5165:TF will be used for the following items and replace the code previously used for these items: 

The Case Manager (CM) should contact the DME Provider prior to adding the planned service item to ensure they are able to provide the item and also obtain the cost of the item with installation.

The DME Provider should provide the CM the cost + installation fee to be used in Harmony when making the planned service request.

The CM must complete the new document titled “ADv – Request for Installed DME” under the Documents Tab of the Member’s Harmony record. 

If the Member is not the homeowner, the document will need to be signed by the homeowner/property manager and uploaded to a plan note using a note type of “Documentation” and note sub-type of “Request for Installed DME”.

On the Planned Service line, the CM must enter the description of the product in the comments area. The Rate per Unit must match the Cost indicated on the ‘ADv – Request for Installed DME’ form.

Misc. Items:

• If more than one DME provider is supplying an installed item, a “Request for Installed DME” document should be completed for each of the DME providers.
• If more than one item is being provided by the same DME the following should be adjusted on the Planned Service line.
  • Units Per Frequency would still = 1
  • Frequency would still = Year
  • Rate per Unit should include the total cost + installation fee for all items and match the total cost on the “Request for Installed DME” document.
  • Comment section should include a list of all item descriptions.

• If the Member is approved for an Installed DME item and then later in the plan year needs another installed DME item, the CM should update the status to “End Service (Provider Use Only)” on the authorized line. This update will remind SPA to end that line when processing the new line, so there is not a claim issue when the provider bills, due to duplicate authorizations.

AGING SERVICES | MEDICAID SERVICES UNIT
ADvantage Administration | State Plan Personal Care
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