DME Navigator® FAQ

For Health Plans

• Why modernize DME benefits management?

  As the demand to care for older, more medically complex members increases and more care moves into the home, health plans must prepare for the shift to a comprehensive solution like DME Navigator to achieve better coordination, transparency, and oversight to support members and clinicians effectively.

• What can health plans achieve with DME Navigator?

  With DME Navigator, health plans can:

  • Deliver faster and more accurate service for members
  • Simplify the experience and workflows for clinicians
  • Eliminate inefficiencies and reduce administrative burden
  • Leverage a national network of DME suppliers that provide high-quality, cost-effective equipment and reliable on-time delivery and equipment support
  • Manage utilization efficiently
  • Deploy claims editing capabilities for payment accuracy
  • Ensure quality and cost are a priority while staying compliant with evolving regulatory requirements
  • Increase transparency for health plans, clinicians, suppliers, and members
  • Reduce DME spend and concurrently improve quality of care and outcomes

• What makes DME Navigator member-centric?

  By integrating the end-to-end experience, we can ensure the right equipment, for the right patient need, at the right time, and for an affordable cost.

  • Get the right equipment with an EHR-integrated digital DME ordering platform, our system showcases in-network suppliers that are ranked on the basis of accessibility, service quality, and cost-effectiveness during service selection.
  • For the right patient need by using integrated evidence-based criteria, streamlining utilization management (UM) processes and providing transparency on order decisions at the point of care.
  • At the right time with streamlined digital processes to enhance patient communication, order tracking, and reliable on-time delivery, minimizing delays, incorrect and incomplete orders.
  • To drive consistent cost savings with reduced waste by enforcing coverage through upstream claims editing and maintain payment accuracy by pricing claims using negotiated, competitive rates.

• What are our program results?

  • Up to 20% PMPY potential savings on average (varies across LOB)¹
  • 95% member satisfaction²
  • 97% reduction in ordering and benefit navigation time for clinicians³
  • Orders are filled 90% faster³
  • 80% faster start of care³

• How does CareCentrix ensure continuity of care and a seamless member experience during transitions to DME Navigator?

  Transitions to DME Navigator are carefully planned and supported, with a primary focus on ensuring continuity of care and a seamless experience for members. We achieve this through:

  • Coordinated Communication: CareCentrix maintains clear, consistent communication with members, providers, and DME suppliers to keep all parties informed and engaged throughout the transition process.
  • Integrated Technology: Utilization of integrated systems allows real-time sharing of member data, ensuring that DME Navigator has access to the latest information for timely and accurate service delivery.
  • Proactive Follow-up: CareCentrix proactively monitors member experiences during transitions and follows up as appropriate to help identify and address any issues, support member satisfaction, and promote a smooth transition experience.
  • Focus on Member Experience: The entire process is designed with a member-centric approach, emphasizing ease of access, clarity, and support to foster trust and confidence in the transition.

• How can I get a demo of DME Navigator?

  Please click here to schedule a demo and explore how DME Navigator can improve your member outcomes and lower costs.

• Will DME Navigator change the equipment I receive?

  Your clinician continues to determine what equipment is clinically appropriate for your care. DME Navigator is focused on how equipment is coordinated and delivered, not on changing clinical decisions.

• Will my upcoming delivery be delayed?

  DME Navigator is designed to improve coordination and visibility into DME orders so equipment can be delivered as efficiently and reliably as possible. Once your order is received, it will be processed based on medical necessity, authorization requirements, product availability, and supplier capacity. If any issue arises that could impact your delivery timeline, you will be notified and provided with updates throughout the process.

• How can I track my equipment order?

  With DME Navigator, you and your care team can track an order from fulfillment to delivery.

  You will receive text messages from DME Navigator letting you know the status of your order, including a tracker once your order has shipped.

• What happens if I already have equipment?

  Existing equipment and ongoing needs are reviewed as part of the care coordination process to help ensure continuity and avoid unnecessary disruption.

• How do I return my equipment?

  If you would like to return your equipment, please contact your physician first to make sure they are in agreement. You may then contact your DME supplier directly to make arrangements for pick up. If you do not have your DME supplier’s contact information, in many cases, it can be found on the equipment.

• What if I was using a different supplier before?

  We understand that many members have strong, trusted relationships with their current equipment providers. In some cases, your supplier may change as part of the transition to DME Navigator. When this happens, continuity of care remains a priority.

  CareCentrix works with a network of credentialed providers who are evaluated for quality, service, and reliability. These providers are focused on delivering high‑quality equipment, timely delivery, and ongoing support to help ensure a smooth and reliable experience for members.

  Transitions are managed carefully, with additional attention given to complex or sensitive needs to help maintain stability and continuity of care.

• Who should I contact if I have questions or concerns?

  If you have questions or concerns about your order, you can easily chat with your DME supplier directly via the digital communication tool, or you may call your DME supplier directly.

• Do I need to learn a new system?

  Where available, DME Navigator integrates into clinical workflows and tools clinicians already use, reducing the need for separate systems. It’s intuitive and easy to use.

• How does DME Navigator fit into clinical workflows?

  DME Navigator combines a technology-enabled point-of-care platform with automated clinical workflows, streamlining the ordering process for clinicians. It brings together an innovative DME marketplace, evidence-based clinical support at the point of ordering, fulfillment transparency, a robust national DME supplier network, and claims reimbursement editing to improve efficiency, visibility, payment accuracy, and the overall clinician experience.

• How does DME Navigator improve the ordering experience?

  DME Navigator provides a centralized ordering hub that streamlines the process from equipment selection through fulfillment. At the point of care, clinicians can:

  • Access real-time, evidence-based support to guide appropriate equipment selection
  • View standardized coverage guidance through a formulary-like structure
  • Select from a network of high-quality, in-network suppliers
  • Receive real-time notifications on order status, supplier acceptance, and delivery updates

  This reduces the need for manual follow‑up and improves order completeness at the time of submission.

• How does prior authorization work?

  Authorization workflows are integrated into the ordering process, enabling more timely and transparent decisions. Clinicians have visibility into requirements earlier in the process, reducing delays and rework.

• How does DME Navigator support clinical decision‑making?

  DME Navigator provides real-time, evidence-based clinical support at the point of care, helping clinicians select appropriate and effective equipment aligned with medical policies. Clinicians also have access to clinical resources, including medical directors and policy support when needed.

  Clinical judgment remains with the ordering clinician. DME Navigator is designed to support—not replace—clinical decision-making by providing better information and visibility.

• How does this reduce back-and-forth after the visit?

  By improving order completeness and visibility at the point of care, DME Navigator helps reduce follow-up calls and documentation requests after the clinical encounter.

• How does DME Navigator improve delivery and fulfillment?

  DME Navigator enhances visibility into the fulfillment process, helping clinicians and care teams stay informed. This includes:

  • Real-time updates on supplier status and inventory where available
  • Notifications on delivery timing and key milestones
  • Electronic confirmation of equipment delivery

  These capabilities help reduce uncertainty and improve coordination across care teams and suppliers.

• What is CareCentrix’s network philosophy for DME suppliers?

  CareCentrix is committed to curating a robust national, regional, and local DME supplier network so members receive the right equipment, at the right time, from a reliable DME supplier, at an affordable cost.

  Access, quality, operational efficiency, and affordability are central to our network strategy. We welcome qualified suppliers who meet our clearly defined standards, and we focus on maintaining a network that supports timely delivery, appropriate setup, and ongoing member support.

  Our credentialed in-network suppliers are evaluated based on service quality, accessibility, and cost effectiveness. Today, CareCentrix has curated a national network of approximately 3,000 credentialed DME supplier locations⁴ to support dependable access to high-quality DME services nationwide.

• How does CareCentrix determine supplier reimbursement rates?

  When establishing supplier reimbursement, CareCentrix uses nationally recognized industry benchmark data to set rates that are fair, reasonable, and aligned with broader market standards. Our rate-setting approach is informed by years of benchmark data.

• What standards are suppliers expected to meet?

  Suppliers are expected to meet defined clinical, service, and operational standards, including licensing, accreditation, and performance expectations.

• How can suppliers request to join CareCentrix’s supplier network?

  You can request to join CareCentrix’s supplier network here.

• How does DME Navigator improve the ordering and fulfillment process?

  DME Navigator streamlines how orders are received, processed, and fulfilled by providing a centralized, single point‑of‑care hub. Suppliers receive more complete and accurate orders, along with improved communication and visibility into order status and key milestones. This helps reduce rework and enables more predictable fulfillment.

• How does DME Navigator improve visibility into coverage and requirements?

  DME Navigator provides greater transparency into coverage and authorization requirements earlier in the process, helping suppliers understand what is needed before fulfillment begins.

  This reduces uncertainty, minimizes follow‑up requests, and improves coordination with clinicians and health plans.

• How does DME Navigator support reimbursement and administrative efficiency?

  DME Navigator supports more consistent documentation, clearer requirements, and improved communication throughout the order lifecycle. This helps reduce administrative back and forth and increases confidence in reimbursement accuracy and processing.