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Medicare: New DME process for select members in multiple states

UnitedHealthcare·CT, DC, DE, ME, MA, NH, NJ, NY, PA, RI, GA · Family Medicine, Internal Medicine, General Practice +8 more·Network News
Effective date
Sep 1, 2026
We identified it
Jul 2, 2026
Days to comply
61 days

Summary

Effective September 1, 2026, Synapse Health will manage DME ordering and fulfillment for select UnitedHealthcare Medicare Advantage plans in multiple states. Providers must transition to prescribing through the Synapse Health e-prescribing portal, and DME suppliers must join the Synapse Health network to continue serving UnitedHealthcare members. This change affects Individual HMO/PPO plans, C-SNP, and D-SNP plans in 11 states, with a defined list of covered and non-covered DME categories.

Action Required

Before Sep 1, 2026
By August 31, 2026: (1) Billing team must identify all Medicare Advantage DME prescriptions for members in affected states (CT, DC, DE, ME, MA, NH, NJ, NY, PA, RI for HMO/PPO; DE, ME, MA, NH, NY, PA, RI for C-SNP; CT, GA, ME for D-SNP). (2) Providers must register and obtain access to the Synapse Health e-prescribing portal and complete training before September 1, 2026. (3) DME suppliers must join the Synapse Health network by contacting JoinOurNetwork@synapsehealth.com or visiting Synapse Health website. (4) Update billing workflows to route all Synapse-managed DME orders through the Synapse portal rather than direct supplier ordering. (5) Identify which DME types your practice prescribes and cross-reference against the Synapse-managed list (CPAP, diabetic supplies, enteral nutrition, home ambulatory, hospital beds, insulin therapy, mobility aids, negative pressure wound therapy, ostomy, oxygen, respiratory equipment, respiratory vest, sleep, urological, ventilators, standard wheelchairs, and wound care). For non-covered DME (bone growth stimulators, cancer treatment, cardiac defibrillators, complex rehab, Optune, oral devices, orthotics, parenteral nutrition, vision, hearing, prosthetics, motorized wheelchairs), maintain existing ordering processes. Failure to use the Synapse portal for covered DME may result in claim denials and service delays. Contact Synapse Health at 888-336-9363 for questions.