Criteria for Apria Capitation
Provider Type
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Medically necessary durable medical equipment (DME) is covered under all health plans. Refer to the Schedule of Benefits and Summary of Benefits and the member's Certificate of Insurance or Evidence of Coverage (EOC) as applicable to determine exclusions and limitations. It must be ordered or approved through the participating physician group (PPG) or Health Net in accordance with policies established by the PPG, Health Net and Medicare.
Covered DME and home respiratory services provided to fee-for-service (FFS) members or members affiliated with a shared-risk participating physician group (PPG) must be obtained through Apria, Health Net's preferred provider for most DME items. Specifically, shared-risk members are capitated to Apria, and shared-risk PPGs should utilize Apria or they will be liable for claims payments.
Apria services include, but are not limited to:
- Comprehensive continuous positive airway pressure (CPAP) services
- DME
- Enteral nutrition therapy
- Home oxygen equipment
- Negative pressure wound therapy
To access a complete list of all therapies and services provided by Apria, providers may log in to Apria's website at www.apria.com.