| FUNDING DIRECTORY |
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Documentation Requirements & Forms | ||||
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Where do I begin? | ||||
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Medicare criteria for Speech Generating Devices | ||||
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Where to send completed forms | ||||
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Locate your ZYGO equipment health plan provider in your state | ||||
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Rental Program Information | ||||
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Funding FAQ | ||||
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Glossary of terms | ||||
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AAC and Funding Resources | ||||
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ZYGO AAC Devices and HCPCS Allowables | ||||
| CLAIMS REQUIREMENTS |
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Client Profile / Client Information Form | ||||
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Copy of all insurance cards (front and back) |
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Assignment of Benefits | ||||
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Co-pay and deductible if there is no secondary insurance |
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Consent Form | ||||
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Speech Therapist's Comprehensive evaluation (dated prior to date of Rx) |
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Physician’s Prescription | ||||
| Samples: |
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Sample Speech Therapists Evaluation | ||||
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AAC-RERC Sample Evaluations | ||||
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DOCUMENTATION REQUIREMENTS Funding a ZYGO communication device through Medicare, state medical assistance programs or private insurance may seem like an overwhelming task. The funding information in this section of our website is designed to walk you through the funding process, and provide you with the information and forms you need for this process. The paperwork generated from this process should be bundled together and sent to your funding resource, whether it is directly to ZYGO Industries, Inc. or to our local authorized dealer in your area. ZYGO or the local dealer then submits the claim on your behalf to the appropriate funding source. To be eligible to receive equipment through insurance, your equipment provider must receive these items prior to delivering equipment to the client. This applies to Medical Assistance funded purchases, rentals, and repairs (must provide month and year of purchase.) Speech evaluations must come from a licensed Speech Language Pathologist, preferably one who is familiar with augmentative and alternative communication devices and other assistive technologies. The recommendation must be for a specific list of equipment and a justification for the medical necessity of each piece. The prescription must be for the specific equipment called out in the speech language pathologist's recommendation. It must be dated prior to equipment delivery, must include the doctor's UPIN, diagnosis, length of need, and an itemized list of specific equipment. Signed originals need to be submitted to ZYGO Industries, or our local authorized dealer, in order for ZYGO to submit a claim on your behalf. The entire packet of items listed in the Claims Requirements section should be sent by the Speech Language Pathologist. |
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