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Funding Package Checklist
Tips for AAC Evaluations
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
ACCI Funding Terminology
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 DenialRequest to Allow Exception for Out of Network Provider AddendumDiscontinued Model AddendumClient Medical Appeal AddendumSample for Proloquo2Go Denial non-participation provider
Sample of Non-Medical Appeals for SGD
Sample Format for Out of Network Provider
Sample Format for Out of Network Provider-Educational Purposes Only Sample Format for Sole Manufacturer - Dedicated ACCI ChoiceRequest to Use Non-Participating ProviderSample Format for Out of Network Provider 10-19Sample for Proloquo2Go Denial non-participation provider
Resources
Reaching Out to Families (Funding Resources)
"Basic Funding 101" - a short video on the funding process
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acci1@earthlink.net
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