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Reminder: Precertification requirements for DME providersgo into effect January 1, 2015

December 1, 2014

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Effective January 1, 2015, durable medical equipment (DME) providers will be required to obtain precertification for all APAP, BiPAP, and CPAP machines and replacement supplies (tubing, water chambers, face masks, etc.) for all commercial and Medicare Advantage HMO and PPO members.

In the first quarter of 2015, enhancements will be made to the NaviNet® web portal to accommodate the submission of these requests through AIM Specialty Health® (AIM), an independent company, using the AIM ProviderPortalSM. In the meantime, providers should continue to submit requests for APAP, BiPAP, and CPAP machines and replacement supplies using the Authorizations transaction in NaviNet.

As of January 1, 2014, ordering physicians began submitting precertification requests for sleep studies and CPAP titration studies in a facility setting through the AIM ProviderPortal. These precertification processes help to ensure that our members receive care that is appropriate, safe, and affordable. More information about this change will be communicated in future editions of Partners in Health UpdateSM.

AIM is an independent company contracted with Independence to perform precertification for select services for most managed care members.

NaviNet® is a registered trademark of NaviNet, Inc., an independent company.

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