Reimbursify Claim Processing Program

Waring Wellness is pleased to announce a NEW SERVICE to help our patients submit out-of-network reimbursement claims to their indivudal health insurances.

Waring Wellness has contracted with Reimbursify, a HIPAA compliant reimbursement program specificially designed to help individuals file out-of-network insurance claims and have these reimbursements sent directly to your mailbox! Quick, easy, and painless.

Your consent below authorizes Waring Wellness to automatically submit claims for reimbursement on your behalf

OUT-OF-NETWORK CLAIM FILING ACKNOWLEDGEMENT

Waring Wellness may utilize the Reimbursify software platform (or directly contact your insurance company by other means) to inquire about plan eligibility, “out-of-network” coverage benefits, deductibles, claim filing procedure, and any other information necessary for filing an insurance claim for clinical services.
Fees for all services provided are still due in full at the time of service, and claims will be filed through Reimbursify only for fully paid services. All applicable insurance reimbursements will be sent directly to you, the patient/main policyholder. Claim submissions are not a guarantee of payment. If you are eligible for out-of-network benefits, your claim will be processed at your insurer’s rate of reimbursement, which ranges from 50% to 80% of the total cost of the claim.
All health insurance claims require at least one diagnosis code (ICD-10 code) to describe the reason for the visit/treatment, and one current procedural code (CPT code) to describe what was performed. We will submit this information as part of your claim. All this information is readily available on the superbill which you may view at any time through the "Payment" tab in your PtEverywhere patient portal.
Occasionally, your insurance company may request additional clinical documentation to justify the reimbursement. When necessary, we will send the minimal information necessary to justify the claim. Since insurance communications can be slow and/or vague, if you directly receive a notice requesting additional information about a claim, please notify Waring Wellness staff as soon as possible and we will fax this information to your insurance provider and/or to Reimbursify representative who is working on your claim.
Waring Wellness staff will submit your out-of-network claims to your insurance carrier on the Friday following each visit. You can check the status of your claim anytime using the Reimbursify mobile app or logging into your account from your PC at www.reimbursify.com.
Your signature below provides permission for Waring Wellness to provide you this service.
Reimbursify works with ALL private health insurance companies, including Military Tricare. Reimbursify does not work with Traditional Medicare, Alaska Medicaid, VA Community Care, Workers Compensation, some EPO plans, and all HMO plans. Reimbursify does not work with secondary health insurance plans.
Waring Wellness is not able to provide health care services to any patient enrolled in the VA Community Care Program, Medicare or Medicaid services. It is against state and federal law for speech-language pathologists (SLPs), occupational therapists (OTs) and physical therapists (PTs) to provide services for cash if the provider is not under contract or agreement with these programs. Unlike physicians, SLPs, OTs, and PTs cannot opt out of the agreement and to accept cash payments from enrolled patients, even if the patient is willing and finacially able to pay for services up front. Feel free to contact your State Senator, your House Of Representative, and your Congressional Representatives and let them know this law clearly needs to be changed.
Please be aware that you, the patient/guardian may opt out of this agreement at any time. To opt out of this service, simply submit your request to the provider through your patient "Message" feature found in your PtEverywhere Patient Portal. Indicate you are no longer wanting Waring Wellness to submit out-of-network claims on your behalf. When you opt out of this service, Waring Wellness will no longer submit reimbursement requests of any kind to your health care provider. You, the patient/guardian, will assume all responsibility for claim submissions after the request has been posted.
This claim submission service performed by Waring Wellness is a pilot program and may terminated at any time by Waring Wellness. The patient/guardian will be notified via patient message in your portal if this pilot program is to be discontinued. In the event the program is terminated, the patient/guardian will assume the responsibility of submitting claims. The patient/guardian may continue submitting claims using the self-service option through Reimbursify or submit directly to the insurance carrier without using Reimbursify.
Waring Wellness can begin submitting claims through Reimbursify after the patient/guardian sets up their FREE account with Reimbursify. The initial setup takes 2 minutes and requires you to upload an image of your insurance card. Waring Wellness cannot begin to submit your claims without this activation step.
Waring Wellness has established a contract with Reimbursify to provide this service for you, free of charge. If you use billing services outside of Waring Wellness or use Reimbursify links that are not part of our contracted service, you may incur user fees. Waring Wellness will not reimburse patients/guardians for any add-on costs that may occur if you elect to use outside service links to seek reimbursement for your claims.
Quick Note: For those filing with Premera Blue Cross Blue Shield, reimbursement checks will be issued and mailed to "Waring Wellness". BCBS has stated their "current policy prevents the company from directly submitting reimbursement payouts DIRECTLY to the consumer." In this event, Waring Wellness will deposit the payment and reissue payment to the patient/main policy holder. Please expect an additional delay of 7-10 business days for any Premera BCBS payouts.

Once we receive this consent form, Waring Wellness will send you an invite to activate your Reimbursify account.

Once set-up, Waring Wellness can begin submitting claims for you.

Expect to receive an email invite from hello@reimbursify.com

Today's Date*

Date

Patient Name*

First NameLast Name

Name of Main Policy Holder/Guardian*

First NameLast Name

Choose one option below:*

I CONSENT for Waring Wellness to submit out-of-network claims on my behalfI DECLINE this service and will self-submit my own claims

Signature of Patient or Guardian*

Login to PtEverywhere Patient Portal

Locate your invoice or superbill. Select the Payment tab.

Payment Tab

Download your invoice to your computer and save to a folder

OR

Take a screenshot of the invoice from your mobile device or computer

Use the PLACE OF SERVICE (POS) Links below. The POS links below contain all the information such as EIN/Tax number, National Provider Identification, Therapist's Name and Address already prepulation into your form.

.

REIMBURSIFY is FREE and ready to use from day one IF YOU USE THE LINKS BELOW:

For Services received at the B Street Clinic

Use this Form Link:

For Services received through TelePractice

Use this Form Link:

For Services received at The Dome

Use this Form Link:

OK! NOW Let's fill out your claim form...

You may see either of these "Welcome Pages." They are both correct and both will process your claim.

Tap the orange + icon on the Claims screen to begin entering claim information.

Register the account using Primary Card Holder's or Subscriber's information. Unless the patient is the primary card holder, Do NOT enter the patient's information here. Enter card holder's:

Tap the name of the patient who received the treatment for this claim.

Tap "Add a new family member" to add a new patient to your account.

Click image below for instructions on how to add another member:

Return to this page to complete instructions on submitting a claims (jotform.com/build/240245319120040)

Enter the date of service

Choose dates on the calendar to specify when the visit(s) took place.

You can select multiple dates if all of the visits had the same codes and fees, which you will enter on the following steps.

Tap the orange continue button.

Step 3

Multi-date filing option:

multi-date filing option

If all of the information on your superbills is the same:

same doctor
same treatment codes
same place of service (11 or 02) (10 + 95 modifier)
same price

Select multiple dates on the "Date of Service" screen, as in the example below then select "continue".

multidate filing

Upload Invoice/Superbill

Tap the orange shutter button to take a photo of your receipt/superbill, or tap the upload icon to select a digital file (PDF) from your phone.

Use the cropping tool to select only the portion of the photo that contains your receipt/superbill. You can submit multiple photos if you are submitting claims for more than one visit.

Step 4

All claims submitted through Reimbursify must be accompanied by a copy of the INVOICE/superbill.

Note: You may be required to grant the Reimbursify app permission to access your phone’s camera or storage in order to submit a superbill.

Superbill Submission Options

OPTIONS for SUBMITTING AN INVOICE/SUPERBILL

Attach a digital copy (PDF) from your phone’s storage or from a 3rd party storage system that can be accessed from your phone (Dropbox, Google Drive or iCloud)

Tap the orange “file upload” icon in the lower right hand corner of the superbill capture screen to launch your phone’s file browser, and then select the “Document(pdf)” option.
Navigate to the superbill for this claim and select “CONFIRM” (or “ADD ANOTHER” if you are submitting multiple claims)

Attach a photograph from your phone’s gallery

Tap the orange “file upload” icon in the lower right hand corner of the superbill capture screen to launch your phone’s file browser, and then select the “Browse Gallery” option.
Navigate to the superbill for this claim and select “CONFIRM” (or “ADD ANOTHER” if your superbill contains multiple pages, or if you are submitting multiple claims)

Take a photograph with your phone

Tap the orange circular “camera shutter” button in the lower center of the superbill capture screen
Use the “grabber handles” to zoom in on just the superbill portion of the image and select “CROP IMAGE”
Select “CONFIRM” (or “ADD ANOTHER” if your superbill contains multiple pages, or if you are submitting multiple claims)

Select Your Provider's Name

Tap the name of the practitioner who provided the treatment for this claim.

Tap "Add a new Practitioner" to add a new practitioner to your account.

KRISTINA WARING MA CCC-SLP is the name of your practioner.

Step 5

Trouble finding your provider's name?

Enter their National Provider Indentification/NPI# instead of their name:

Waring Wellness / Kristina Waring MA CCC-SLP NPI: 1659402659

Enter Diagnosis Code

Tap the "Diagnosis Code" field to enter the ICD10: diagnosis code(s) for this claim.

Diagnosis codes can be found on your invoice/superbill.

Diagnosis codes are also referred to as "ICD-10" codes or "DX" codes. These codes start with a letter followed by a number, i.e., "F44.4" or "J38.3" or "R49.0"

Tap the orange "Add" button after you have typed a code, to add it to the claim.

Tap the orange "Continue" button bottom right hand corner after you have added all of the diagnosis codes for the visit.

diagnosis code

Enter Service Code

Tap into the "Service Code" field to enter the service code(s) for this claim.

Service codes can be found on your invoice/superbill. Services codes are also referred to as current procedural termonolgy/CPT or procedural codes.

These codes are always five digits, i.e., "92524" or "92507."

Next, enter the amount from the invoice in to the "$ Fee" box.

The fee is what you paid, for the procedure and should include any discounts that may have been applied to your bill. It does not include add on fees such as products purchased.

Tap the orange "Add" button to add this information to the claim.

Tap the orange "Continue" button bottom right corner after you have added all of the service codes and fees for the visit.

CPT codes

Enter Modifier or Units

Add any units applicapable to the service code. By Default all services codes have at least 1 unit. Others will be marked on the invoice as 2, 3, 4, etc.

Modifiers indicate that the treatment was different or altered by some specific circumstance.

The only Modifier used regularly is 95 which is added when a visit is a telepractice visit:

92507 1 unit 95 modifier

Most CPT codes are 1 unit, but many physical or manual therapy procedures, can be applied in 15-minute increments and contain a maximum number ranging from 4-7.

Tap the orange "Apply Units/Modifiers" button after all information has been entered.

Review the Details and Submit

Review the details of your claim. If correct, tap the orange "Submit" bottom right corner and send it on its way to your insurance company.

(Note: you should NOT be asked to submit payment for processing your claim. Your Provider has paid this fee for you. If you are using a link other than the place of service links provided above or below, then you are a page outside Waring Wellness claims assistance. Use the links below to assure you are using the correct FREE form.

5660 B Street Clinic, Anchorage AK 99518

(in-person visit place of service 11)

TelePractice or Virtal visit

(place of service 10 or 02 modifier 95)

6501 Changepoint Dr. Anchorage, AK 99518

(Modifier 11)

Claim Submitted

Your claim is now on its way to your insurance company, and you will receive an email from Reimbursify confirming your submission.

You can view the status of your claim at any time by selecting the

"Sent to Insurance" tab on your REIMBURSIFY Claims dashboard.

Reimbursify Customer Care