CurrentHumanaPolicy CP2015007

DMEPOS Proof of Delivery Documentation

Requires DMEPOS suppliers to retain and produce proof of delivery (POD) documentation to Humana for Medicare Advantage, Commercial, Medicaid and Dual Medicare‑Medicaid products to validate billed equipment and supplies.

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 proof of delivery (POD) documentation and make it available to Humana upon request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Medicare Advantage, Commercial, Medicaid, Duallines of business covered

MPIM ch.4.26 & 5.8external standards cited

POD available on requestsupplier requirement

Denial / overpayment recoveryconsequence for missing documentation

Proof of Delivery Coverage Criteria

Proof of Delivery documentation requirements

Humana policy stance and operational requirements for POD documentation:

Suppliers must maintain complete and accurate proof of delivery (POD) documentation, consistent with applicable standards (Medicare Program Integrity Manual chapters 4.26 and 5.8 or relevant state statutory/regulatory requirements).

Suppliers (in‑network and out‑of‑network) must make POD documentation available to Humana upon request.

Charges lacking appropriate supplier POD documentation may be denied and Humana may require reimbursement of any overpayment.

This policy applies to Medicare Advantage, Commercial, Medicaid and Dual Medicare‑Medicaid products.

Claims remain subject to other plan requirements such as medical necessity, reasonableness, and applicable referral or authorization rules.

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 proof of delivery (POD) documentation and make it available to Humana upon request.

SourceLink

On This Page

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Supplier Responsibilities and Operational Requirements

Documentation Required

Retain and produce complete POD on request

Suppliers must retain complete and accurate proof of delivery (POD) documentation and make it available to Humana upon request; charges lacking appropriate POD may be denied and Humana may require reimbursement of any overpayment.

POD verifies member receipt and supports correct coding and billing for claims.
Applies to Medicare Advantage, Commercial, Medicaid and Dual Medicare‑Medicaid products; in‑network suppliers must follow state requirements where applicable or Medicare Program Integrity Manual standards (chapters 4.26 and 5.8) when state requirements are absent.
Failure to produce POD upon request may result in claim denial and recovery of overpayments.

Key Definitions

Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) — definition entries

TermDurable medical equipment, prosthetics, orthotics and supplies (DMEPOS)

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.

ScopeIncludes items and services covered under Original Medicare fee schedules as well as comparable items typically included in those schedules.

Overpayment — definition entry

TermOverpayment

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

ConsequencePayments determined to be overpayments may be subject to recovery per Humana policy and applicable regulations.

OpenPayer

DMEPOS Proof of Delivery Documentation

Proof of Delivery Coverage Criteria

DMEPOS Scope and Codes

Supplier Responsibilities and Operational Requirements

Key Definitions