Tag: third-party administrators
Molina Healthcare taps DME Navigator platform to manage DME benefits in three more states
June 23, 2026HME News Staff
YARMOUTH, Maine – Molina Healthcare of Iowa will implement a new DME Navigator program for members in all lines of business starting in the fall. The payer also has plans to use the platform in Nebraska and Wisconsin.
What durable medical equipment providers in Iowa need to know:
Molina is subcontracting the DME network to Optum for the in-scope DME products and services.
CareCentrix will contract, credential and manage a network of DME providers rendering in-scope products and services...
In brief: Molina’s next implementation, Medline’s fire response, MiniMed’s Flex
June 22, 2026HME News Staff
YARMOUTH, Maine – Molina Healthcare of Iowa will implement a new DME Navigator program for members in all lines of business starting in the fall. The payer also has plans to use the platform in Nebraska and Wisconsin.
What durable medical equipment providers in Iowa need to know:
Molina is subcontracting the DME network to Optum for the in-scope DME products and services.
CareCentrix will contract, credential and manage a network of DME providers rendering in-scope products and services...
Providers didn’t ask for it, but it’s here
June 22, 2026Liz Beaulieu, Editor
Going into Medtrade in March, I assumed the biggest topics of conversation would be CMS’s next round of competitive bidding and its new moratorium on new supplier numbers.
Those issues were certainly discussed, but by far the most dominant – and most charged – topic on the show floor was the accelerating use of benefits managers and third‑party administrators to manage durable medical equipment products and services.
Just prior to Medtrade, we published a story on BlueCross...
Association leaders use State Summit to align TPA response
June 19, 2026HME News Staff
WATERLOO, Iowa - VGM’s recent State Leader Summit gave association leaders something they rarely get: A chance to sit in the same room at a moment when the home medical equipment (HME) industry needs a coordinated response to the accelerating shift to third-party administrators (TPAs).
In recent months, insurers in states from Tennessee to Washington state have tapped TPAs to manage their HME benefit.
“Currently, we've got the third-party administrator piece floating through...
Payer relations: Have a game plan
May 13, 2026Cadie McGonagill
Q. What can we do about a payment system that's failing DME suppliers?
A. Intermediaries and third-party administrators (TPAs) have become significant players in how durable medical equipment reaches patients. For DME businesses serving everyday communities, the burden is becoming difficult to sustain.
As the prevalence of TPAs supporting Medicaid Managed Care and Medicare Advantage payers trends upward, our industry needs a game plan to respond to an evolving model that, without proper...
Payers move deeper into TPA model, according to poll
May 1, 2026Theresa Flaherty
YARMOUTH, Maine – The accelerating shift to third‑party administrators (TPAs) appears to be gaining steam: Ninety‑two percent of respondents to a recent HME Newspoll say payers are already using or transitioning to this model, and most of the rest expect it within a year.
“I think this has the potential to be very disruptive and negative for small DMEs,” wrote one respondent. “The TPAs don’t seem interested in engaging suppliers of our size that have a personal...
AMA recommends oversight of TPAs
November 16, 2022HME News Staff
HONOLULU – The American Medical Association decided at its interim meeting here to recommend that third-party administrators of specialty pharmacy benefits be included in state and federal oversight efforts of prescription drug middlemen. Regulation of pharmacy benefit managers is on the rise in response to concerns that they can have a detrimental impact on the ability of patients to access affordable prescription drugs and, for specialty pharmacy benefits, TPAs provide many of the same services,...
Providers struggle with TPAs
November 15, 2019Liz Beaulieu, Editor
YARMOUTH, Maine - The resurgence of third-party administrators for HME is bad news for the industry, according to the large majority of respondents to a recent HME Newspoll.TPAs are unnecessary middlemen between insurers and providers, further complicating an already complex system, respondents say.“We don't need another level of bureaucracy that has to be paid by somebody, typically the provider in the long run,” wrote one respondent.Eighty-six percent of respondents report currently...