How to dispense and get paid for resupply during the first 90 days after a patient’s coverage moves to Synapse Health.
When a patient’s health plan moves to Synapse Health, transition data from the prior plan is often incomplete or delayed. Because you have the most current insight into that patient’s supply history, you are permitted to complete the initial post-transition resupply dispense yourself. This keeps care continuous and reduces administrative burden on both sides.
This article covers what the resupply transition program allows, which patients and product categories qualify, the documentation Synapse Health needs to reimburse you, and what changes once the first supply is out the door.
What the resupply transition program allows
For up to 90 days after a patient’s plan transition, you can process and dispense up to 90 days’ worth of resupply orders for eligible patients. You are permitted to complete the initial resupply dispense for 90 days post transition date.
Synapse Health will reimburse you as the subcontractor for these orders once you submit the required documentation.
After the initial supply, Synapse Health takes over all future resupply operations. The expectation is that you turn off all proactive resupply programs for those patients.
Which patients and categories are eligible
Patients transitioning to Synapse Health who need resupply within 90 days of their transition date are eligible. The applicable categories are:
- Diabetes (excluding CGM)
- Wound care (notes are needed for payment)
- Urology
- Ostomy
- Enteral
- PAP resupply
Payment limits and exclusions
Eligibility alone does not guarantee payment. Three limits apply:
- Medicare coverage criteria – Synapse Health will only pay for orders that meet the Medicare coverage criteria
- Medicare fulfillment limits – orders must fall within Medicare limits for fulfillment quantities and standards
- Prior authorization categories excluded – categories that require prior authorization (like CGM) are excluded from the program
What to submit with each resupply order
Required documentation
Submit a valid SWO (Standard Written Order) and proof of delivery that meets Medicare documentation standards. Specifically:
- Valid SWO – a Standard Written Order for the item dispensed
- Proof of delivery (POD) – POD that meets Medicare documentation standards, including mail tracking
- Packing slip with SKU-level detail – for example, ResMed F30 Full Face Mask A7030, Size Small, Quantity 1
- Wound care notes – for wound care, include valid monthly face-to-face notes
If a patient has a financial hardship, notify Synapse Health in the Connect or Fulfill portal when you submit the order.
How and when to submit orders
- Submit completed orders as post-dispensed transactions through Connect Portal
- Submit qualifying documents within 7 days of fulfillment or date of service within Connect or via API/SFTP
- Provide the completed documents (packing list, POD, SWO and so on) at a minimum on a weekly basis – best practice is to provide them daily via the Connect Portal
What to watch for after the first supply
- Update your systems to show Synapse Health as the payer
- Watch for duplicate dispensing
- Make sure auto-dialers are turned off after the first supply
- Expect that Synapse Health may audit orders and confirm quantities
- Do not collect patient cost-share – Synapse Health is responsible for collecting any patient cost-share amounts
Where to send questions
If patients have questions, encourage them to contact Synapse Health directly. Providers with questions about the program can use the same number or email the DME provider support team.
Resupply program contacts
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Provider and patient phone line
1.888.336.9363 -
DME provider support email
DMEProviderSupport@synapsehealth.com
