Durable Medical Equipment Solution
Manage durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) review, delivery, and member education so equipment supports safe, timely recovery.
Optimizing durable medical equipment management
DMEPOS supports members’ recovery, mobility, and daily living after illness, injury, or hospitalization. Carelon’s Durable Medical Equipment Solution helps Medicare health plans manage DMEPOS as part of the care transition, not as a stand-alone equipment transaction.
We connect clinical review, authorization, delivery coordination, and member education across the care transition. This approach supports appropriate and timely access to equipment, provides safeguards against duplication, and gives plans visibility into utilization.
Lines of business:
- Medicare
Audience:
- Payers
What should durable medical equipment management deliver?
Managing DMEPOS across disconnected requests, coverage rules, suppliers, discharge plans, and member education can create delays and unnecessary utilization. We focus on three outcomes: appropriate equipment selection, timely access, and less waste across the DME experience.
Support faster decisions for appropriate equipment
Clinical review evaluates DMEPOS requests against clinical guidelines, member needs, coverage criteria, and plan policy. Requests that meet criteria can be approved quickly, while complex cases receive additional review.
Support safe discharge with equipment delivery planning
Carelon coordinates with providers and suppliers so equipment can be delivered and set up before discharge when possible. This can help members return home with the equipment they need and reduce delays that keep them in higher-cost settings.
Reduce duplication and improve visibility
Safeguards help identify overlapping or unnecessary equipment requests, while reporting gives health plans better visibility into utilization, supplier workflows, and care coordination opportunities.
Our DME solution by the numbers
Types of durable medical equipment
Durable medical equipment, prosthetics, orthotics, and supplies include a broad range of items used to support recovery and daily living. Examples include:
Durable medical equipment: oxygen equipment, wheelchairs, walkers, crutches, and other equipment used for mobility or daily tasks.
Prosthetics: devices that replace missing body parts, such as limbs or medically necessary breast prostheses after mastectomy.
Orthotics: devices that support, align, prevent, or correct body function, such as leg or ankle braces and lumbar support braces.
Medical supplies: wound dressings, ostomy products, incontinence products, and other items used in treatment or recovery.
Inside our Durable Medical Equipment Solution
These capabilities help manage DMEPOS from request review through delivery, training, monitoring, and reporting.
Clinical appropriateness review
Evaluate equipment requests against coverage criteria, clinical guidelines, member needs, and plan policy
Coverage and policy alignment
Apply local and national coverage determinations, state guidelines, and health plan policy during DMEPOS review
Portal-enabled authorization
Use a provider portal and decision-support workflow to simplify eligibility, benefits verification, and approvals
Pre-discharge equipment planning
Coordinate delivery and setup before discharge so equipment supports a safe transition home
Member education and provider collaboration
Partner with DMEPOS providers so members receive training on ordered equipment and supplies
Duplication safeguards
Identify overlapping or unnecessary equipment requests to reduce waste and avoid overutilization
Advanced analytics and reporting
Track utilization, identify care coordination opportunities, and inform plan reporting
How our solution works
Request
Providers submit a request for durable medical equipment, prosthetics, orthotics, or supplies.
Review
The platform evaluates the request against clinical guidelines, coverage criteria, plan policy, and member needs.
Determine
Requests that meet criteria can be approved quickly; complex requests move to clinical review for additional evaluation.
Coordinate delivery
Carelon works with providers and suppliers to support timely delivery, often before the member returns home from a facility.
Educate and support
Members receive training on ordered equipment and supplies so they can use them safely and with more confidence.
Monitor and report
Request data is tracked to provide visibility on utilization, identify care coordination opportunities, and support health plan reporting.
Ask us about our Durable Medical Equipment Solution
Contact us to learn more about the possibilities and impact of our Durable Medical Equipment Solution.
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Frequently asked questions about durable medical equipment solutions
Member and provider inquiries
Are you a health plan member? If you have a question about your health plan, please call the Member Services number on the back of your health plan ID card.
Provider inquiries: For questions about a request or portal support, call 1-844-411-9622 or contact our support team.
For questions about the provider network, call 1-833-585-6262 or email our network team.
1 Source: Carelon internal data, 2023.