Product Overview

The DME Navigator is a specialized product within ABM designed to manage and administer DME benefits. It includes:

Utilization Management: Ensures appropriate use of equipment through pre-service authorizations.
Order Management: Facilitates equipment ordering workflows.
Provider Network Management: Maintains and optimizes supplier directories.
Claims Processing: Handles both pre-adjudication and postpay claims workflows.

Technical Architecture & Workflow

Pricing Orchestration: DME pricing is handled via orchestration services that reduce dependency on CES and enable flexible innovation.
Claims API Services: Supports both prepay and postpay claims editing, integrated with CareSelect and CDSS services.
Medical Network Integration: ABM acts as both a payer and submitter, managing claims and sending 277 responses through its CES instance.

Implementation Models
ABM supports two main integration types for DME:

PostPay Pipeline:

Clients send claims in ABM CDM format.
Examples: MVP, MMO, Presbyterian.
Implementation time reduced from 18 months to under 9 months.

Service Implementation Manager (SIM):

Clients send claims in custom formats.
Examples: BCBST (migration), Healthfirst (migration), Wellmark (new client).
SIM connects directly to ABM’s postpay pipeline, removing the need for client-side development.

Partnerships & Clients
ABM’s DME services are delivered through partnerships with:

Avalon
CareCentrix
Parachute Health
Palmetto GBA