Role required: Organization administrator
ResMed ReSupply uses payor information to determine which supplies a patient is eligible for. In some cases, you may need to add a new payor when a patient switches to an insurance provider that's not in the system.
Add a payor
If a payor is not in the payor list, you can add a payor:
- From the Administration menu, select Payors.
- Click Add payor.
- From the Payor name list, select a payor.
- From the Status list, select a status.
- From the Replacement reason required? list, select Yes or No.
- From the Eligibility schedule list, select an appropriate eligibility schedule.
- From the Reimbursement rates list, select a set of rates.
- Select the check boxes beside the required order documents.
- In the Add an alternative name for this payor field, enter any alternative names that are used for this payor.
- Click Save.
Replacement reason required?
Replacement reasons are an additional set of questions in the resupply questionnaire that inquire about the functional condition and quantity on hand for individual supplies. The additional set of questions are:
- Is [your item] dirty?
- Is [your item] damaged?
- How many [items] are on hand?
Tip: If you service Medicare patients, you may be required to assess whether supplies remain functional, providing replacement supplies only when an item is no longer able to function.
An Eligibility schedule tells the platform how often a patient becomes eligible for individual supplies. If you don't find the preferred eligibility schedule in the list, you need to create one.
Reimbursement rates help you track the rate for which a payor reimburses individual supplies. If you don't see the reimbursement rate schedule in the list, you need to create one.
You can specify which documents a patient requires to be compliant. From the Required documents list, select the documents you'd like ResMed ReSupply to notify you about before they expire.
Alternative names for this payor
Alternative names allow you to apply nicknames to payors for matching purposes when importing patients.
Let's say you use the abbreviation, BCBS, or BC in your system of record for Blue Cross Blue Shield. In ResMed ReSupply, the payor appears as Blue Cross Blue Shield. Instead of changing the payor name in your system of record from BCBS to Blue Cross Blue Shield, you simply add BCBS as an alternative name. At the time of import, the system matches all patient records containing BCBS to Blue Cross Blue Shield.