CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Durable Medical Equipment (DME) diabetic supplies - Dual CONNECT (HMO D-SNP)

Lists durable medical equipment (DME) diabetic supplies available at participating pharmacies for Neighborhood Dual CONNECT (HMO D-SNP) members and explains that some additional supplies may be covered when medically necessary. Applies to members of Neighborhood Health Plan of Rhode Island's Dual CONNECT (HMO D-SNP).

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyDurable Medical Equipment (DME) diabetic supplies - Dual CONNECT (HMO D-SNP)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionObtain a prescription and verify prior authorization or quantity limits for specific DME diabetic supplies when required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multipleexplicitly listed diabetic supply products

participating pharmacieslocation for obtaining supplies

possibleprior authorization risk

Coverage criteria for DME diabetic supplies

Coverage conditions

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Prescription and vendor: Member has a prescription and fills the DME diabetic supply at a participating pharmacy or DME vendor listed in the Neighborhood CONNECT Provider and Pharmacy Directory.

Supports brand/manufacturer agnostic coverage when filled at participating vendor

Listed or medically necessary: The item is either specifically listed in the policy's product list OR the item is not listed but is considered medically necessary and authorized by Neighborhood Health Plan of Rhode Island.

Providers may request coverage for unlisted items by documenting medical necessity

Prior auth/quantity limits: If the product is subject to prior authorization or quantity limits, those requirements must be met.

Some products may require prior authorization and/or have quantity limits

The policy does not list every possible DME diabetic supply. It states that items not shown may still be covered when considered medically necessary, and providers may request coverage for unlisted supplies by documenting medical necessity and working with Neighborhood. Coverage is not limited by brand or manufacturer when items are filled at a participating DME vendor or pharmacy.

Coding and listed products

Listed branded products (no billing codes provided)mixed

LANCETS	ANY
ACCU-CHEK AVIVA PLUS TEST STRIPS	ROCHE DIAG, Product Name = ACCU-CHEK AVIVA PLUS TEST STRIPS
ACCU-CHEK GUIDE TEST STRIPS	ROCHE DIAG, Product Name = ACCU-CHEK GUIDE TEST STRIPS
ACCU-CHEK SMARTVIEW TEST STRIPS	ROCHE DIAG, Product Name = ACCU-CHEK SMARTVIEW TEST STRIPS
ACCU-CHEK COMPACT PLUS TEST STRIPS	ROCHE DIAG, Product Name = ACCU-CHEK COMPACT PLUS TEST STRIPS
ACCU-CHEK GUIDE METER	ROCHE DIAG, Product Name = ACCU-CHEK GUIDE METER
ACCU-CHEK GUIDE ME METER	ROCHE DIAG, Product Name = ACCU-CHEK GUIDE ME METER
ACCU-CHEK AVIVA PLUS METER	ROCHE DIAG, Product Name = ACCU-CHEK AVIVA PLUS METER
ACCU-CHEK NANO METER	ROCHE DIAG, Product Name = ACCU-CHEK NANO METER
ACCU-CHEK CONTROL SOLUTION	ANY ACCU-CHEK CONTROL SOLUTION

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Provider actions and requirements

Prior Authorization

Prior Authorization Required

Some listed DME diabetic products may be subject to prior authorization and/or quantity limits. Check plan rules before ordering to avoid delays or claim denials.

Prior authorization may be required for certain DME diabetic supplies
Quantity limits may apply to specific supplies

Documentation Required

Prescription and Documentation Required

Providers must submit a valid prescription for covered DME diabetic supplies when dispensing through a participating pharmacy or DME vendor. Ensure documentation supports medical necessity and retains records in the patient chart.

A prescription is required to obtain covered DME diabetic supplies at a participating pharmacy
Covered diabetic supplies are not limited by brand or manufacturer when filled at a participating DME vendor
Providers may request coverage for medically necessary DME diabetic supplies not listed by submitting supporting documentation

Denial Risk

Denial / Quantity Limit Risk

Claims may be denied or limited if supplies require prior authorization and one is not obtained, or if quantities exceed plan limits. Verify benefit rules, prior authorization status, and allowable quantities before submitting claims to reduce denial risk.

Claims can be denied or limited for missing prior authorization
Exceeding quantity limits may result in claim denials or member liability

Note

Provider Resources and Contact

For help locating participating DME vendors and pharmacies or for prior authorization assistance, contact Member Services or refer to the Neighborhood CONNECT Provider and Pharmacy Directory.

Provider and Pharmacy Directory: www.nhpri.org/DualCONNECT
Member Services: 1-844-812-6896 (TTY 711), hours vary seasonally

Background

This policy lists specific diabetic supplies and devices that members may obtain at a participating pharmacy or participating DME vendor with a prescription. It also explains how to find participating vendors via the Neighborhood CONNECT Provider and Pharmacy Directory or Member Services and notes that some products may require prior authorization or be subject to quantity limits.

Definitions

Participating vendor

DefinitionParticipating DME vendor or pharmacy: a supplier listed in the Neighborhood CONNECT Provider and Pharmacy Directory where members may obtain covered diabetic supplies.

Where to findNeighborhood CONNECT Provider and Pharmacy Directory on www.nhpri.org/DualCONNECT or call Member Services at 1-844-812-6896 (TTY 711).

Prescription requirementCovered DME diabetic supplies must be obtained at a participating pharmacy or DME vendor with a prescription.

Brand policyCovered diabetic supplies are not limited by brand or manufacturer when filled at a participating DME vendor.

Operational hours for directory supportMember Services: Oct 1–Mar 31: 8:00 a.m.–8:00 p.m., seven days a week; Apr 1–Sep 30: 8:00 a.m.–8:00 p.m., Monday–Friday (voicemail available weekends/holidays).

Medical necessity for unlisted items

Unlisted item coverage

Medical necessity for unlisted items

Provider request: Provider documents medical necessity and requests coverage for a DME diabetic supply not listed in the policy.

Neighborhood may approve unlisted items if medically necessary; requests should follow plan processes for authorization.

Rental and purchase rules

Topic	Policy statement
Rental vs. purchase	The document does not specify rental versus purchase rules for DME diabetic supplies.
Implication for providers/members	Providers and members should assume no separate rental vs. purchase guidance is provided in this policy; verify billing and acquisition terms with the participating DME vendor or pharmacy and consult Neighborhood for item‑specific authorization or coverage questions.

Replacement

Replacement details

Replacement intervalsNot specified in the policy; replacement timing for DME diabetic supplies is not defined.

Replacement authorization for unlisted itemsIf a supply is not listed, providers may request coverage by documenting medical necessity; Neighborhood may approve replacements when medically necessary.

Prior authorization impactSome products may be subject to prior authorization and/or quantity limits which could affect replacement approvals.

Place of service for replacementsReplacements must be obtained at a participating pharmacy or DME vendor listed in the Neighborhood CONNECT directory.

Documentation requirements

Documentation Required

Prescription plus prior authorization/quantity limit adherence required

Providers must ensure a prescription is obtained and that any applicable prior authorization and quantity limit requirements are satisfied for products subject to those rules.

Maintain prescription documentation and prior authorization approval in the patient record.
Confirm quantity limits before ordering and document adherence to limits on claims.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyDurable Medical Equipment (DME) diabetic supplies - Dual CONNECT (HMO D-SNP)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionObtain a prescription and verify prior authorization or quantity limits for specific DME diabetic supplies when required.

SourceLink

On This Page

OpenPayer

Durable Medical Equipment (DME) diabetic supplies - Dual CONNECT (HMO D-SNP)

Coverage criteria for DME diabetic supplies

Coding and listed products

Provider actions and requirements

Background

Definitions

Medical necessity for unlisted items

Rental and purchase rules

Replacement

Documentation requirements

Not covered items