New Invoice Requirements and Payment Methodology for Manually Priced Durable Medical Equipment (DME) Codes Effective January 1, 2018

Date: 11/02/17

Effective for services rendered on or after January 1, 2018, NH Healthy Families is implementing a new invoice requirement and payment methodology for DME items that NH Healthy Families considers manually priced codes.

For all codes that are manually priced, please submit the manufacturer’s cost invoice. The invoice must include all of the following:

·         Manufacturer’s name

• Provider’s name
• Purchase date
• Product Description and HCPCS code associated
• Quantity purchased
• MSRP* cost per item

Additional billing details:

·         When the order fulfilled is for more than one member, please denote on the invoice which items and quantity are delivered to the member in question on the claim

·         Shipping and handling is not reimbursable by NH Healthy Families

*Effective for dates of service on and after January 1, 2018, the payment methodology for manually priced claims will be Manufacturer’s Suggested Retail Price (MSRP) minus 25%. The invoice must show the MSRP cost in order for NH Healthy Families to adjudicate the claim appropriately. 

Unacceptable invoices include:

·         Non-manufacturer invoices

·         Online order confirmations

·         Manipulated invoices, i.e. white-out or stricken out documentation (note: adding HCPCS codes to the invoice is acceptable)

Please contact Provider Services at 1-866-769-3085 with any questions.