Skip to main content

 

ResMed Help Center

Manage eligibility schedules

ResMed ReSupply enables you to create and edit eligibility schedules so you can determine which items are close to becoming 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 item 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. For example, a patient’s mask eligibility is set to 90 days. The patient is eligible after 90 days from the last supplied date for their mask. Patients are often eligible for many supplies at one time. ResMed ReSupply starts the eligibility period again when a supply request is processed and considered shipped. If a patient receives supplies through another system, update the last supplied date for the supplies in ResMed ReSupply so eligibility is calculated correctly.

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

No, eligibility for new supplies is only one of the criteria ResMed ReSupply uses to determine when it contacts a patient. ResMed ReSupply outreaches patients when they are eligible for a mask and the system has not reached out to them in the last 90 days. ResMed ReSupply never contacts a patient if their notification preference is set to "Do Not Contact" or they are inactive.

What if I need to remove an item from an eligibility schedule completely?

If a payor does not allow coverage for a specific item listed in the eligibility schedule, change the quantity option to 0.  

Mask components cannot be set to 0. 

Step-by-step instructions

View an eligibility schedule

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

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 name for the eligibility schedule.
  4. In the resupply schedule, modify each item:
  • From the list on the left, select the number of eligible items.
  • In the frequency field on the right, select or enter the number of days required for eligibility.
  1. Click Save.

Update an eligibility schedule

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