All PlansAdministrativeHigh impact
26-1042 Route Covered DME and Home Respiratory Services Referrals to Apria
Health Net·CA·Prior Authorization
We identified it
Sep 12, 2026
Summary
Health Net now requires all covered DME and home respiratory services referrals to be routed exclusively to Apria Healthcare, their preferred contracted provider. Shared-risk PPGs that refer DME to other suppliers may face capitation payment deductions. Billing teams must immediately update referral workflows and staff procedures to direct all eligible DME and respiratory service referrals to Apria via fax (888-492-0010) or phone (888-492-7742).
Action Required
IMMEDIATELY: (1) Referral coordinators and billing staff must update all DME and home respiratory services referral workflows to route referrals exclusively to Apria Healthcare. (2) For shared-risk PPGs: Cease referring covered DME to any supplier other than Apria to avoid capitation payment deductions. (3) Billing team and office staff must register with ApriaLink to submit orders online. (4) Update referral templates, encounter forms, and standing orders to specify Apria as the required DME/respiratory services vendor. (5) Document all referral requests submitted to Apria and retain for compliance verification. (6) If no response from Apria within 24 hours, escalate to Apria's Central Intake and Admissions team at 888-492-7742 or contact the onsite review nurse. (7) Communicate this mandatory referral change to all providers, physician groups, and ancillary staff. Failure to comply will result in capitation payment deductions for shared-risk arrangements and delayed member access to covered services.