A patient’s eligibility for new supplies is determined by the following:
- Last date a patient received supplies
- Patient’s payor (insurance) plan
- Patient’s HME notification period (the default period is 90 days)
When a patient is eligible for new supplies, ResMed ReSupply contacts the patient once a week for five weeks or until the resupply questionnaire is completed.
Resupply notifications are sent via email, automated interactive voice response system (IVR) call, and/or text message (SMS). A patient can change their notification preference in the patient portal or call the ReSupply Client Services team. An HME can temporarily disable (pause) notifications for a patient, organization location, an organization's payor and call schedule.
ResMed ReSupply schedules the next notification based on the date a supply request was made, the HMEs notification period and the payor rules.
Opt out or do not contact
Patients can choose not to receive notifications and not be contacted. However, they can still see their eligible items in the ResMed ReSupply patient portal and can contact the ReSupply Client Services team.
ResMed’s eligibility engine uses the patient’s payor plan and the last supplied date for times to determine if a patient is eligible for reimbursement of new supplies.
When you create a new patient profile, you must provide the patient’s payor information for either a Medicare or non-Medicare plan. For non-Medicare plans, patients must answer additional questions and provide the reason for the replacement supplies to confirm their eligibility. These questions are asked when the patient completes the ResMed ReSupply questionnaire, or speaks to a client services representative/IVR system.
Each payor plan has a resupply schedule for ResMed ReSupply-supported items within the Healthcare Common Procedure Coding System (HCPCS). Every HCPCS has a quantity and timeframe that define eligibility for resupply. For example, one mask every 90 days. You can change the resupply schedule for each payor plan as required.
ResMed ReSupply monitors a patient’s eligibility for items on a daily basis. The resupply questionnaire, ad-hoc supply requests and in-person supply requests are used to determine resupply eligibility.
Note: ResMed ReSupply manages supply requests that are entered within its system only. If a supply request was entered in another system, eligibility reimbursement for requested supplies is not guaranteed.
Insurance verification (add-on feature)
During insurance verification, the system checks to see if the patient's insurance information is valid and what types of coverage they have on their plan.
Details about co-pays, deductible owing and coverage amounts are not checked.
Your organization can set up automatic or manual insurance verification.
Note: Additional service fees apply when you use the insurance verification feature. Contact your ResMed representative for more details about the additional fees.
Automatic insurance verification (add-on feature)
If automatic insurance verification is turned on for your organization, a patient’s insurance is automatically verified when they submit a supply request, once per day.
Note: The patient's payor and member ID must be in their ResMed ReSupply profile to complete an insurance check.
All customer information is fictional.
Manual insurance verification
To manually verify insurance, go to the patient's profile > Patient details > Payor details > Verify insurance.
This can take up to 24 hours to complete.
Integrated supply request fulfillment
ResMed ReSupply supports integrated supply request fulfillment for VGM and PPM fulfillment. To select a fulfillment partner, see Updating organization details. Integration with a fulfillment partner is not a requirement.
When you confirm a supply request, ResMed ReSupply chooses the fulfillment method preferred by the patient’s HME. You also have the option to choose manual fulfillment for a supply request.
A confirmed supply request that uses either VGM or PPM fulfillment is flagged by the ResMed ReSupply supply request service. The confirmed supply request is then sent electronically to a third-party service. The third-party service notifies ResMed ReSupply when the supply request ships.