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Reminder Regarding Reimbursement for Durable Medical Equipment

In an effort to ensure that reimbursement for durable medical equipment (DME) is made in accordance with existing Blue Cross and Blue Shield of North Carolina (BCBSNC) medical policies, please be aware that reimbursement will be denied for certain DME items if they are supplied by any provider who has not met eligibility and/or credentialing requirements. 

The following information regarding this stipulation is reference in several BCBSNC medical policies:

“DME, when eligible for coverage, is covered under the Durable Medical Equipment provision of the member benefit.  The DME supplier must meet eligibility and/or credentialing requirements as defined by the Plan (i.e., BCBSNC) to be eligible for reimbursement.”

For your convenience, here is a list of the BCBSNC medical policies in which the statement above is referenced, and in which it is clearly stated that only a BCBSNC contracted and credentialed DME provider can be reimbursed for supplying DME items to our members: 

  • Sleep Apnea: Diagnosis and Medical Management  (i.e., CPAP, BiPap)
  • Air-Fluidized Beds
  • Children’s Mobility and Positioning Equipment
  • Noninvasive Respiratory Assist Devices (i.e., BiPap)
  • Patient Lifts
  • Pressure Reducing Support Surfaces
  • Speech Generating Devices
  • Wheelchairs

Please remember that DME equipment ordered during an inpatient stay should not be billed until the day of discharge (This statement added 1/14/14 to 1/9/14 original article).

BCBSNC will accept new credentialing applications from providers who believe they meet DME eligibility and/or credentialing requirements.

If you have any questions, please contact the Provider Blue LineSM at 1-800-214-4844.