Change to durable medical equipment incontinence quantity limits
Effective May 1, 2020, HealthKeepers, Inc. will change its reimbursement policy and related claims processing rules associated with all incontinence supplies for Anthem HealthKeepers Plus members.
HealthKeepers, Inc. will no longer reimburse for any amount of incontinence supplies that exceeds the Department of Medical Assistance Services’ benefit limits for Anthem HealthKeepers Plus members who are 21 years or older.
For all members younger than 21 years, HealthKeepers, Inc. will reimburse providers for quantities prescribed by a physician and documented on a Certificate of Medical Necessity at https://dmas.kepro.com/content/forms.aspx. HealthKeepers, Inc. will perform periodic, random audits of all incontinence services to ensure that Anthem HealthKeepers Plus members are receiving the appropriate supplies.
Providers can follow the claims payment disputes process and submit medical records, which will be reviewed on a post-services basis. We recommend that providers visit the online provider manual to review all appeals and reconsideration processes at https://mediproviders.anthem.com/va.
If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.
April 2020 Anthem Provider News - Virginia