MedicalHTR Billing Process
A SelectSmart.com Flowchart by dgalvan21
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It will answer a question

               
 
 
Intake Specialist needs to verify eligibility for both IN & OUT NETWORK benefits: to include auth/referral requirements, out of pocket, claims address, etc.
 
 









 
 
Does it require a referral/authorization? Verify where the referral/authorization request can be made via phone, fax, etc.
First, Can HTR bill IN NETWORK for this claim?
YES
Process order entry in Brightree. Initiate and obtain authorization or refrerral if applicable under HTR; discuss out of pocket with patient if applicable






NO



 
 
Second, can HOMELINK/ VGM bill INNETWORK for this claim? Is the insurance or network affiliated with them in any way?
YES
Go to vgmhomelink.com; go to dealer tab; go to patient referral; complete all fields and submit Follow instructions to fully process referral?
Once complete with intake part give to Sarah to notify sales rep on approval to fit or order item for patient




NO





Lastly, does the patient insurance or network offer any type of out of networks benefits; before we redirect claim
NO
Third, can Mediquip bill INNETWORK for this claim?
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
YES
Has order already been provided or supplied to patient?
YES
Homelink will fax an order confirmation, with reimbursement rates for you to sign and approve prior to billing

YES


YES




NO


YES
Verify requirements with insurance company; especially if a special OON authorization needs to be initiated.
Refer back to initial verification of benefits. Is authorization or referral required?
 
Homelink will call and review rates prior to sending confirmation of referral
YES
Before accepting rates partner with Billing or Office Manager on rates being offered by Homelink. Did management approves....



YES





YES

YES
Process order entry in Brightree. Initiate and obtain authorization for OON coverage; discuss out of pocket with patient if applicable
Please contact Stephanie Hernandez at Mediquip to initate authorization request. Phone # 949.443.4423 Fax# 949.487.4763
Did Mediquip obtain authorization from insurance provider?
Get written documentation and order confirmation on referral to includes rates that were accepted.Ask them to proceed with order.
YES
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.


YES


NO

YES




Once complete with intake part give to Sarah to notify sales rep on approval to fit or order item for patient
Verify requirements with insurance company; especially if a special OON authorization needs to be initiated.
Process order entry in Brightree. Initiate and obtain authorization for OON coverage; discuss out of pocket with patient if applicable
 
Once complete with intake part give to Sarah to notify sales rep on approval to fit or order for patient.