Reimbursement Support
The information on this page is intended for healthcare providers.
Mainstay Medical’s ReActiv8 Support & Verification Program (RSVP) is facilitated by experienced access specialists who will work directly with your office and your patient’s health insurance company in an effort to obtain coverage for the ReActiv8 system. The RSVP team will submit a prior authorization request (if applicable) and appeal service denials, until a final decision is made. Although there can be no guarantee of coverage approval, our program continues to work on your patient’s behalf until all avenues are exhausted.
RSVP Program
The RSVP Program can increase your patient’s access to ReActiv8 therapy through the submission of comprehensive requests for prior authorization, patient-based appeals with insurance companies, and external reviews if necessary.
You will provide your patient with clinical documentation to support a letter of medical necessity that your patient will submit to their insurance company requesting prior authorization for ReActiv8. If your patient’s health plan approves, no further action is required, and the ReActiv8 procedure may be scheduled.
This process may take 15-30 days once the request is submitted.
If your patient’s health plan denies their authorization request, an RSVP Prior Authorization Specialist will help them submit an appeal letter with their clinical records in an effort to demonstrate medical necessity. Our team will seek up to two levels of internal appeals on your patient’s behalf, although their plan may only require one level. If the plan approves, no further action is required and your patient’s ReActiv8 procedure may be scheduled.
This process may take 30-45 days after an appeal is submitted. If a second internal (Level 2) appeal is available, it may take an additional 30-45 days.
If your patient’s health plan denies their internal appeal(s), they may be able to request an External Review with an Independent Review Organization (IRO). An RSVP Prior Authorization Specialist will facilitate this process on your patient’s behalf. The decision of the IRO is binding and represents the last step in the appeals process.
This process may take 45-60 days once the external review request is submitted.
Reimbursement Information
Download the 2023 Reimbursement Guide for Physicians and Facilities
Coding, Coverage & Reimbursement Support
(763) 270 – 5312
reimbursementsupport@mainstaymedical.com
(763) 270 – 5305
Reimbursement Legal Disclaimer
The totals, projections, and estimates contained in these Mainstay Medical (“Mainstay”) coverage and reimbursement materials, are intended for general guidance and informational purposes only. Mainstay cannot represent or guarantee that the anticipated revenue, costs, financial returns, or any other numerical figures in these materials, are accurate or will be achieved through the furnishing of Mainstay products. Because every physician and provider’s situation is different, providers must conduct their own research through their billing department, consultant(s), and/or legal counsel, regarding ReActiv8 coverage, coding and reimbursement, costs, overhead, etc., to determine estimates relevant to their organization.
