UHC delays Synapse arrangement 

MINNEAPOLIS – UnitedHealthcare recently notified HME providers that it is delaying the implementation of its new capitated arrangement with Synapse Health for standard DME in Georgia and North Carolina, AAHomecare has reported. 

The arrangement, which impacts the insurer’s Medicare Advantage plan members enrolled in HMO and PPO plans in the two states, will now go into effect Sept. 1 instead of Aug. 1 to allow more time for providers to familiarize themselves with new processes and requirements, the association says. 

AAHomecare recommends that providers thoroughly read and understand the requirements and standards laid out in Synapse Health’s DME Provider Handbook. The association highlighted these in particular: 

• Section 2 – DME Performance Standards – page 6: 

• Maintain 24−hour on-call coverage seven days per week and respond to Synapse Health within 30 minutes of call, including after normal business hours, weekends and holidays. 

• Do not attempt or collect member/patient copayment, coinsurance or deductible amounts. Synapse Health collects all member/patient payments. 

• Section 3 – DME Orders & Delivery – pages 6-9: 

• Standard Orders: Providers are required to access, fulfill and respond by accepting or rejecting the order within two hours of the email notification.  

• STAT Orders/Hospital Discharge Orders: Providers are required to access, fulfill and respond by accepting or rejecting the order within one hour of the email notification. 

• STAT Orders: Orders that have the checked “STAT” indicator box are considered STAT and require 1-2 hour or, up to, a 4–6-hour delivery time window and are dependent on clinical need. In the event the provider cannot fill the order on the indicated day, the provider will message Synapse Health by using the NOTES feature in the Fulfill portal to communicate an alternative date/time when the order can be fulfilled. 

• Urgent Requests: The DME provider has a responsibility to promptly address urgent requests for the maintenance or replacement of durable medical equipment. This typically involves making an in-person visit to the patient's home or residence. During regular business hours, the urgent request will be communicated to the DME provider through the standard order email notification process and by phone. In the case of after-hours urgent requests, Synapse Health will reach out to the DME providers on-call or after-hours contact. The DME provider is required to respond to Synapse Health within 30 minutes of receiving the request and ensure the delivery of the urgently requested durable medical equipment within four (4) hours.  

• Section 4 – Patient Transfers – pages 10-11:  

• When a provider becomes subcontracted with Synapse Health, patient care and management shift to Synapse Health as the new provider of record. This transition ensures that patients continue to receive the highest quality of care and services seamlessly under the Synapse Health Network. 

AAHomecare says it met with UHC in late June to discuss the new arrangement and to share the concerns it has received from members in Georgia and North Carolina. 

The association says the new arrangement will impact about 480,000 members in the two states and noted that, if expanded to other states, it could impact millions more. 

• UHC entered into the capitated arrangement earlier this year. 

• Synapse’s Tony Kilgore says the goal of the new arrangement is simplifying the DME process. 

• But providers are finding it hard to see the benefits of the new arrangement, especially from a reimbursement perspective.