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DME Navigator®

Our integrated durable medical equipment (DME) solution helps health plans manage spend while improving the experience for members, DME suppliers and the ordering providers.

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Modernize durable medical equipment with a member-centric experience

It’s time to reevaluate your Durable Medical Equipment (DME) benefits management strategy. Optum has collaborated with CareCentrix, a leader in health care at home, to offer a comprehensive DME benefits management solution that strengthens member satisfaction outcomes and lowers costs.

Improve your DME workflow by adopting modern practices and leveraging technology. Transition away from paper-based and fax-driven processes, so you can enhance transparency, streamline operations, and provide real-time insights to all stakeholders. This transformation will lead to faster service delivery, more coordinated care and improved member experiences.

Key benefits

Revolutionize your healthcare experiences by enhancing service quality. 

EHR-integrated digital ordering platform

Our system showcases vetted, in-network suppliers, ranked based on accessibility, service quality, and cost-effectiveness during service selection.

Integrated evidence-based criteria

Evidence-based criteria is integrated into the ordering platform with streamlined utilization management (UM) processes providing transparency on order decisions at the point of care.

Streamlined digital processes

Enhance patient communication, order tracking, and reliable on-time delivery—minimizing delays as well as incorrect and incomplete orders.

Consistent cost savings

Reduce waste by enforcing coverage through upstream claims editing and pricing, using negotiated, competitive rates.

Reevaluate your DME benefits management strategy

Considering that the number of Americans aged 65 and older is projected to nearly double—from 52 million in 2018 to 95 million by 2060—now is the opportune moment to reevaluate your DME benefits management strategy.

  • Enhanced savings: 5–20% PMPY potential savings on average (varies across LOB)2
  • Faster service: 80% faster start of care
  • Increased safety: 63% reduction in adverse discharge events related to DME3

  

DME Navigator FAQ

Yes. Clinicians order DME in workflow. Eligibility and status return in the EHR to reduce toggling and delays.

It’s up to 90% faster. Launch coverage reports significant order time reduction, helping accelerate care transitions and avoid discharge delays.

It’s currently more than 3,000 locations and expanding. The program continues to add suppliers, including rural and limited-distribution channels. 

ePA is built into the workflow. We surface plan criteria at order time and align with CMS-encouraged FHIR ePA (CRD/DTR/PAS). Interfaces are confirmed during onboarding.

Yes, where partners are ready. Ordering is EHR-embedded today and can align to HL7 FHIR postacute orders for DME. 

Through a credentialed network. The DME Navigator program handles:

  • Contracting
  • Credentialing
  • Performance 

This is so members receive timely, appropriate equipment.

Yes. We integrate to your current X12 278 environment and support the industry transition to FHIR ePA (CRD/DTR/PAS). 

Industry insights

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Creating a Seamless Durable Medical Equipment Experience

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Creating a seamless durable medical equipment experience

Discover how a digital-first DME strategy can enhance efficiency and transparency for health plans, clinicians and members.

See how Optum can help make your DME spend more affordable

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  1. U.S. Census Bureau. The graying of America. 2018.
  2. CCX/Optum joint analysis of savings potential based on current market data. Potential estimated savings (%) will vary by health plan and actual potential savings will be updated after a specific health plan data run.
  3. PH data analysis; 2023.