UPDATE: Previous changes in DME incontinence quantity limits
In March 2020, HealthKeepers, Inc. informed Anthem HealthKeepers Plus providers that the plan was aligning incontinence benefit limits with those of the Department of Medical Assistance Services (DMAS). This policy only affected members 21 and over. However, these limits did not go into effect on May 1, 2020, as scheduled.
On June 1, 2020, HealthKeepers, Inc. removed all benefit/quantity limits for incontinence supplies for all Medallion and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) members of all ages (see DMAS Appendix B for impacted codes).
HealthKeepers, Inc. will reimburse DME providers for all quantities prescribed by the member’s physician and for services documented on a Certificate of Medical Necessity. HealthKeepers, Inc. will perform periodic reviews of all incontinence services to ensure that members are receiving the appropriate amount of supplies.
Reminder: Medicaid does not reimburse for incontinent briefs or incontinent under pads for children under the age of 3 years.
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.
July 2020 Anthem Provider News - Virginia