CurrentHumanaPolicy CP2015007

DMEPOS Proof of Delivery Documentation

This policy governs Humana's requirements for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers to retain and produce proof of delivery (POD) documentation for Medicare Advantage, Commercial, Medicaid and Dual Medicare-Medicaid products. It affects in-network and out-of-network DMEPOS suppliers billing Humana plans.

Policy Summary

PayerHumana

PolicyDMEPOS Proof of Delivery Documentation

Policy CodePolicy CP2015007

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSuppliers must retain complete and accurate POD documentation and make it available to Humana upon request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

MedAdv, Comm, Medicaid, DualLines of business covered

Retain PODDocumentation requirement

Denial & OverpaymentConsequence for missing POD

MPIM ch4.26 & 5.8Federal guidance cited

Proof of Delivery — Coverage Actions

POD documentation coverage criteria

Covered when ALL of the following are met:

Suppliers must retain complete and accurate proof of delivery (POD) documentation and make it available to Humana upon request.

When relevant state statutory or regulatory POD requirements exist, suppliers must follow those requirements; otherwise suppliers must follow the standards in the Medicare Program Integrity Manual (chapter 4, section 4.26 and chapter 5, section 5.8).

Applies to both in-network and out-of-network DMEPOS suppliers billing Humana plans across Medicare Advantage, Commercial, Medicaid, and Dual Medicare-Medicaid products as specified.

Claims lacking appropriate supplier POD documentation will be denied and any overpayment must be reimbursed to Humana.

Service Category and Codes

Policy Summary

PayerHumana

PolicyDMEPOS Proof of Delivery Documentation

Policy CodePolicy CP2015007

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSuppliers must retain complete and accurate POD documentation and make it available to Humana upon request.

SourceLink

On This Page

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Supplier Documentation & Obligations

Documentation Required

Maintain and Produce POD; denials and overpayment recovery

Humana requires DMEPOS suppliers to retain complete and accurate proof of delivery (POD) documentation and to make that documentation available to Humana upon request; if a service lacks appropriate supplier POD documentation, Humana will deny the charge and require reimbursement of any overpayment.

Maintain complete and accurate POD documentation consistent with Medicare Program Integrity Manual chapters 4.26 and 5.8.
Produce POD documentation to Humana upon request.
Absence of appropriate supplier POD documentation will result in denial of the charge and requirement to reimburse any overpayment.

Billing Rule

Supplier obligations: follow state rules or Medicare standards; provide POD on request

In-network and out-of-network DMEPOS suppliers must maintain complete and accurate POD documentation consistent with applicable state statutory/regulatory requirements; when state requirements are absent, suppliers must follow the Medicare Program Integrity Manual (chapters 4.26 and 5.8). Humana may deny charges and require reimbursement when POD is not provided.

In-network suppliers: follow relevant state statutory/regulatory requirements; if none, follow Medicare Program Integrity Manual chapters 4.26 and 5.8.
Out-of-network suppliers: maintain POD consistent with relevant state statutory/regulatory requirements.
Make POD documentation available to Humana upon request; lack of POD triggers denial and overpayment recovery.

Key Terms

DMEPOS — definition for services included in Original Medicare's DMEPOS Fee Schedule and PEN Fee Schedule.

TermDMEPOS

DefinitionAll services included in Original Medicare's DMEPOS Fee Schedule; all services included in Original Medicare's Parenteral and Enteral Nutrition Items and Services (PEN) Fee Schedule; and all services that, though not included in those fee schedules, are of a kind that is typically included in those fee schedules.

ScopeApplies to durable medical equipment, prosthetics, orthotics and supplies billed to Humana plans.

Overpayment — definition describing amounts to the DMEPOS supplier for services that lack documentation.

TermOverpayment

DefinitionAn amount to the DMEPOS supplier for a service that lacks documentation.

ConsequenceWhen POD or required documentation is absent, the charge may be denied and any overpayment must be reimbursed to Humana.