Skip to Content

Provider Manual

Durable Medical Equipment - Home Respiratory Equipment

Last Updated on August 28, 2018

Security Health Plan has affiliated providers for DME and home respiratory equipment who have 24-hour-a-day, 7-day-a-week service throughout the Security Health Plan service area. For a current list of affiliated DME/respiratory equipment providers refer to the Security Health Plan Provider Directory.

Security Health Plan covers medically necessary standard, not deluxe, durable and respiratory equipment for enrollees. Security Health Plan retains the option of rental or purchase of equipment. For coverage questions, contact 1-800-548-1224.

Guidance to DME providers on coverage and claim submission

Policy

Security Health Plan follows DME-MAC coverage criteria, Advance Beneficiary Notice, and capped-rental rules for its individual, group and third-party administration products as well as for Family Health Center. For additional detail and instruction, please reference the DME-MAC Jurisdiction B Supplier Manual and Local Coverage Determinations available on the National Government Services website.

Provider responsibility

  • Prior to dispensing any item, documentation should be on file indicating all applicable DMERC coverage criteria are met.
  • Prior to dispensing items listed under a miscellaneous code or items not covered under a DMERC policy, contact Security Health Plan for coverage and eligibility information.
  • Security Health Plan will provide advance determination of coverage if the HCPCS code for the item is listed in Medicare’s Advance Determination of Medicare Coverage policy.
  • Before repairing equipment, contact Security Health Plan for coverage and eligibility information.

Billing

Use the CMS 1500 form to bill Security Health Plan for services you provide to its members. Please use the appropriate CPT code and diagnosis code for that member to ensure that services provided are applied to the appropriate member benefit limits under the mandate.