It will answer a question
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Intake Specialist
needs to verify eligibility for both IN & OUT NETWORK benefits: to include auth/referral requirements, out of pocket, claims address, etc.
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Does it require a referral/authorization? Verify where the referral/authorization request can be made via phone, fax, etc.
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First, Can HTR bill IN NETWORK for this claim?
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YES
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Process order entry in Brightree. Initiate and obtain authorization or refrerral if applicable under HTR; discuss out of pocket with patient if applicable
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NO
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Second, can HOMELINK/
VGM bill INNETWORK for this claim?
Is the insurance or network affiliated with them in any way?
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YES
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Go to vgmhomelink.com; go to dealer tab; go to patient referral; complete all fields and submit
Follow instructions to fully process referral?
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Once complete with intake part give to Sarah to notify sales rep on approval to fit or order item for patient
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NO
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Lastly, does the patient insurance or network offer any type of out of networks benefits; before we redirect claim
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NO
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Third, can Mediquip bill INNETWORK for this claim?
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HOMELINK/
VGM will be in contact with you if any other demographic information is needed for them to certify this order can be processed through them
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YES
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Has order already been provided or supplied to patient?
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YES
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Homelink will fax an order confirmation, with reimbursement rates for you to sign and approve prior to billing
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YES
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YES
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NO
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YES
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Verify requirements with insurance company; especially if a special OON authorization needs to be initiated.
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Refer back to initial verification of benefits.
Is authorization or referral required?
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Homelink will call and review rates prior to sending confirmation of referral
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YES
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Before accepting rates partner with Billing or Office Manager on rates being offered by Homelink.
Did management approves....
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YES
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YES
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YES
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Process order entry in Brightree. Initiate and obtain authorization for OON coverage; discuss out of pocket with patient if applicable
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Please contact Stephanie Hernandez at Mediquip to initate authorization request.
Phone # 949.443.4423 Fax# 949.487.4763
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Did Mediquip obtain authorization from insurance provider?
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Get written documentation and order confirmation on referral to includes rates that were accepted.Ask them to proceed with order.
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YES
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Verify in Brightree that Homelink VGM is listed as the insurance company. Anything that VGM has issued referral; needs to be billed directly to them not the actual insurance company.
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YES
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NO
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YES
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Once complete with intake part give to Sarah to notify sales rep on approval to fit or order item for patient
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Verify requirements with insurance company; especially if a special OON authorization needs to be initiated.
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Process order entry in Brightree. Initiate and obtain authorization for OON coverage; discuss out of pocket with patient if applicable
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Once complete with intake part give to Sarah to notify sales rep on approval to fit or order for patient.
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HTR Billing Process
