08/03/2022
UHC-Proof of Delivery Required with Patient Signature for Dispensing of Orthotics
We have been recently experiencing payment issues on orthotics with United Healthcare in NYC. Our billing service claims that UHC now mandates a POD (proof of delivery) form with a patient signature when the orthotics are dispensed. They state that the date of the dispensement much MATCH the date of billing for the orthotics (L3000). Have other practitioners experienced this?
Per document #CDG.009.24 (which covers all DME items), there are certain items that have specific coverage criteria, and others that do not have specific guidelines- orthotics fall into that general category. Since specific coverage guidelines do not exist, the following criteria must be met for United Healthcare to cover the orthotics:
- Ordered by a physician; and
- The item(s) meets the plans Medically Necessary definition (refer to the member specific benefit plan document); and
- CMS DME MAC criteria are met (see above link); and
- The item is not otherwise excluded from coverage
DME Items should be billed to insurance when they are dispensed.
Below is the link to the policy that was reviewed.