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ResMed Help Center

Managing eligibility schedules

This page enables you to create and edit eligibility schedules so that you can determine which HCPCS supply items are to become eligible for reimbursement based on a payor's (insurance provider's) coverage policy.

How does ResMed ReSupply know when a patient is eligible for resupply?

The ResMed ReSupply eligibility engine checks each HCPCS the patient is prescribed, calculates the amount of time since the product was last supplied and compares it to the resupply frequency of the patient’s payor plan. If the amount of time since the patient was last supplied is greater that the patient’s resupply frequency of the item, the patient is eligible for resupply of that specific item. A patient can be eligible for any number of items at one time. Each time a supply request is processed in ResMed ReSupply, the last supplied date of each item on the supply request is updated when the item ships. ResMed ReSupply only tracks supply requests and shipments processed in ResMed ReSupply. There is no integration with billing systems or insurer payment systems. If a patient informs a ResMed ReSupply user they received new supplies through another system, the user can enter that item's last supplied date into ResMed ReSupply to update the eligibility engine.

Is a patient outreached as soon as they are eligible for new supplies?

No, eligibility for new supplies is only one of the criteria used to determine when a patient is contacted. A patient is outreached when they are eligible for new supplies and ResMed ReSupply has not called or emailed them in the last 90 days. A patient is never contacted if their notification preference is set to "Do Not Contact", or they are inactive.

To view an eligibility schedule:

  1. From the Administration menu, select Eligibility schedules.
  2. Under the Name column, select the eligibility schedule.

To create an eligibility schedule:

  1. From the Administration menu, select Eligibility schedules.
  2. Click Add eligibility schedule.
  3. In the Schedule name field, enter a suitable name for the eligibility schedule.
  4. In the resupply schedule, modify each item:
  • From the drop-down list on the left, select the number of eligible items.
  • From the drop-down list on the right, select the number of days required for eligibility.
  1. Click Save.

To update an eligibility schedule:

  1. From the Administration menu, select Eligibility schedules.
  2. Click the name of the eligibility schedule.
  3. Click Edit. Enter all required details.
  4. Click Save to update details, or Cancel to keep original settings.