How to Obtain Funding

For individuals seeking funding for a Speech-Generating Device (SGD), the funding process can feel overwhelming. Working through the submission regulations and ensuring you have the right documents filled out correctly can be time-consuming and frustrating.


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The PRC Funding Department is experienced at navigating the rules, requirements and potential pitfalls involved in working with so many different providers.

We understand the process, and will work with you to ensure success.

We are guided by our dedication to our mission: Because everyone deserves a voice.

Download our Funding Quick Reference Guide.

 

Necessary team members:

Other possible team members:

  • Family/guardian/caregiver
  • Occupational therapist
  • Physical therapist
  • Teacher
  • Rehabilitation counselor

Find out what type(s) of health insurance coverage the client has. This can be anything from state Medicaid to Medicare, private insurance to Tricare (military coverage) – or a combination of these.

It’s important to call the insurance provider to check on coverage for durable medical equipment (DME) or, more specifically, speech-generating devices (SGDs).

Ask if the policy covers the following codes:

  • E2510 (SGD)
  • E2599 (SGD Accessories)
  • E2512 (Mounts)

A full and complete evaluation is the key to ensuring that a device will be funded.

Regional Medical Review Policy (RMRP) Guidelines* require that the following information be documented in the SGD evaluation report:

  • Client’s Background Information
  • Speech and Language Abilities
    • Receptive
    • Expressive
  • Cognitive Abilities
  • Physical Abilities
  • Mobility Status
  • Hearing and Vision
  • Daily Communication Needs
  • Rationale for Device Selection
  • SGDs Considered and/or Tried
  • Recommended SGD and Accessories
  • Functional Communication Goals
  • Treatment Plan, Disclosure, and Signature

Please be sure the report is signed!

*Please note: Medicare and most funding sources follow these guidelines, as well.

Use the following as a checklist. Depending on where you live and your funding source, you may need more – or less – documentation; work with your PRC Consultant and our Funding Department to ensure you have everything you need.

A complete funding packet includes:

    • A physician’s prescription and/or a Certificate of Medical Necessity (CMN) for the SGD. Make sure to include any accessories on the prescription (keyguards, NuEye™, NuPoint™, switches, mounting systems etc.).
    • Legible copies of the front and back of ALL of the client’s insurance cards (Medicare/Medicaid/Private Insurance Cards)
    • An Assignment of Benefit and Patient Release Form/Client Information Form/ (AOB/CIF)
    • The SLP's SGD evaluation report that supports the need for the speech generating device.
Make sure the report is signed!
  • Equipment Selection Sheet(s) to ensure proper equipment/ configuration is ordered
  • If requesting a device rental, a signed trial evaluation contract
  • State Medicaid requirements may dictate other forms. See website for these state-specific forms.

PRC is pleased to announce that submission packets can quickly, easily and securely be uploaded via our website. Simply drag-and-drop onto the page, and your documentation will be received and ready for processing.

Uploaded documents must be physically signed by necessary team members prior to being uploaded to PRC’s website.

Packets may also be submitted via fax or mail service:

PRC Funding Department
1022 Heyl Rd.
Wooster, OH 44691
Fax: 330.263.4829

Packets are accepted via email ONLY from encrypted servers!

If you have any questions on submitting your paperwork, please call us: 800.268.5224.

Once we receive your paperwork, the PRC Funding Department team gets to work.

We will:

  • Verify the client’s insurance eligibility to ensure the submission is forwarded to the proper funding source(s).
  • Review all documentation and contact the SLP or family for missing information.
  • Submit the paperwork to the appropriate funding source(s).

You can help to expedite the process by:

  • Ensuring that all paperwork is filled out completely. Common issues that hold up paperwork include:
    • Missing policy holder signature on AOB/CIF
    • Missing SLP signature on evaluation
    • Different items being requested across equipment selection sheet, prescription and report. This needs to be the same in all three places.
  • Copying your PRC Consultant on any email correspondence to the funding department.
  • Be patient, but persistent. Don’t hesitate to check with your Consultant on the status. If you have specific questions on missing information, contact our Funding Department.
  • If the device is approved, PRC will confirm the order with the family before shipping.
  • If the device is denied/ deferred, PRC will contact the evaluator with information on appealing the decision.

Congratulations!

Once your PRC AAC device has arrived, notify your team of the good news.

After opening the box, review the contents. Double-check that everything you’ve ordered is enclosed.

Attach any accessories to the device, and then turn it on. If it needs to be charged, plug it in.

Set the device to the recommended vocabulary, choose a voice and then set and adjust the access method (if included) so the client can make selections on the device accurately and efficiently.

If at any point you need assistance, contact your PRC Consultant. He or she will provide training on device setup, operation and implementation.





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