Forms

At Second Act we strive to provide you with the most current information regarding insurance requirements and how to get insurance reimbursement for the items you purchase. The Pre-visit Registration Form gives you, our clients, the opportunity to provide us with your relevant information for verification prior to your visit.

To receive insurance reimbursement for your items, you must have a valid prescription from your medical provider. The Standard Written Order, or SWO, was introduced in January 2020 by Medicare and most private insurance companies follow these same guidelines. The Standard Written Order Requirements document outlines what forms this new, SWO, replaces and how the SWO needs to be completed by your ordering provider to qualify as a valid prescription. We have also included our version of that Order and it includes all the information necessary to be included on the prescription/medical order that your medical provider issues so insurance will pay your claims.

For your reference we have also included a glossary of medical and insurance terms and a document that explains which of your documents are considered medical records. If your insurance claim is denied and you want us to appeal it, we will need to request your medical records from your medical providers.

The remaining documents in this list are provided for your information but they do not require any action by you prior to your visit. If any of these are relevant to your visit we will explain them when you are here.

Please feel free to download any of these forms. If you have questions about any of them, please call or email us.

Pre-visit Registration Form

Standard Written Order

Standard Written Order Requirements

Medical And Insurance Terms Glossary

Medical Records Defined

Upgrades and Modifiers

ABN English

ABN Spanish

ICD10 List