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Funding Services

Funding Services

 

Funding Package Checklist

 

A Guide That Outlines the Forms Necessary to Start the Process of Obtaining a Device For Your Clients

Required Funding Documents                       

Forms: (Certificate of Medical Necessity (CMN), Client Information & Assignment of Benefits Form) to be completed and returned to ACCI.  Augmentative Communication Consultants, Inc.

Supporting Documents                                        

 Forms for Client to read

ACCI Funding Terminology

List of Funding Definitions 

Sample AAC Speech Language Evaluation

Speech Language AAC Evaluations    (Completed by the Speech Language Pathologist before Script is written).                                                                                                          

Tools

Locating a Speech Language Pathologist, Selecting a Speech Language Pathologist

Sample Addendums for Clarification or Support of Device

Addendum to Evaluation Report Denial
Request to Allow Exception for Out of Network ProvideAddendum
Discontinued ModeAddendum
Client Medical Appeal Addendum

Sample of Non-Medical Appeals for SGD

Sample of Non-Medical Appeal

Sample Format for Out of Network Provider

 

Sample Format for Out of Network Provider-Educational Purposes Only 
Sample Format for Sole Manufacturer - Dedicated ACCI Choice
Request to Use Non-Participating Provider
Sample Format for Out of Network Provider 10-19

 

Resources 

Reaching Out to Families (Funding Resources)

 

   

ACCI Lending Agreement

 Forms for Conditions and Terms for Lending Equipment

   
Funding Video

"Basic Funding 101" - a short video on the funding process                                              

Ready to submit your paperwork?         

ACCI                                
P. O. Box 731  Get social-Stay in touch for the latest news and information!
Moon Township, PA  15108                                           facebookiconlittle.jpg     twitter-small.jpg    youtube2.jpg
 Fax:      412-269-0923  
 Phone:  800-982-2248  

 

Copy and paste our email address

to your contact list

                 

  acci1@earthlink.net

 

    
   
   

 

 

 

 

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