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Medicare: New DME process for select members in multiple states
Act
by Aug 31, 2026
Effective date
Sep 1, 2026
Identified
Jul 2, 2026
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.
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What to do
by Aug 31, 2026 · 8 steps
01Billing 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).
02Providers must register and obtain access to the Synapse Health e-prescribing portal and complete training before September 1, 2026.
03DME suppliers must join the Synapse Health network by contacting JoinOurNetwork@synapsehealth.com or visiting Synapse Health website.
04Update billing workflows to route all Synapse-managed DME orders through the Synapse portal rather than direct supplier ordering.
05Identify 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).
06For 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.
07Failure to use the Synapse portal for covered DME may result in claim denials and service delays.
08Contact Synapse Health at 888-336-9363 for questions.
Original notice
Medicare: New DME process for select members in multiple states
uhcprovider.com · Always check the source before changing claims.
Related changes
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