Click button to send fax

Brightree’s Electronic Fax
Automatic, Integrated, Paperless CMN Faxing
Make manually faxing and receiving Certificates of Medical Necessity (CMNs) a thing of the past with
Brightree’s Electronic Fax. Once again, Brightree has revolutionized how providers run their businesses
by delivering an innovative way to fax CMNs without paper, eliminating hours spent printing and faxing
CMNs. Brightree’s Electronic Fax delivers a new and better way.
Before providers can bill, a signed CMN must be obtained from the doctor in most cases. Streamlining this
laborious process dramatically improves the productivity and efficiency of your staff … and your cash flow.
Here’s how it works:
The old way.
OUTBOUND FAXING
1. Print the CMN
2. Manually generate a cover letter
3. Locate doctor’s fax number
4. Walk to fax machine
5. Manually fax to doctor
INBOUND RECEIPT OF FAXES
1. Wait for a reply
2. If not there, run and sort report.
3. Call doctor
4. Walk to fax machine
5. Re-fax
6. Wait again …
Brightree’s Electronic Fax CMN
A new way. A better way.
OUTBOUND FAXING
1. Click button to send fax
INBOUND RECEIPT OF FAXES
1. Alert tells you which CMNs are not
returned
Click button to re-send
2. When faxes are received signed CMN
is displayed on screen
Verify info and log CMN and
bills are automatically
released
Sign up TODAY, and you will enjoy fully-integrated capabilities that allow you to:
Automatically generate the CMN as a PDF file, as well as create a fax cover sheet containing the
physician’s fax number
Communicate with the fax partner to monitor the status of the fax effort
Receive automatic updates of the results of the transmission from within Brightree
View alerts via the Inbound Fax feature when a signed CMN has been returned
Automatically route CMNs into a patient’s electronic file cabinet, which further automates
procedures, saves paper, and saves the step of physically scanning the CMN. (For Brightree
Document Management customers only)
Getting started is easy. Simply choose a plan that best meets your needs and complete a short registration
form. Brightree can typically activate your Brightree Electronic Fax CMN account within 10 business days.
For questions or to get started, please call Tim Harper at 1.888.598.7797 ext. 786 or email
[email protected].
Brightree’s Electronic Fax Services Order Form
By signing below, Brightree customer (Licensee) agrees to pay the listed Monthly Fee for the selected plan in
accordance with the payment terms defined in the Licensee’s Business Solutions Provider Agreement (BSP), and
will be bound by the terms and conditions of the BSP. Licensee can change the Level of Service once annually.
Please sign & return this page to Brightree
FAX:
888.789.0921
LEVEL OF
SERVICE
MINIMUM
MONTHLY FEE
DESCRIPTION
Local
Fax
Service
•
•
•
•
Includes OUTBOUND and INBOUND faxing
Toll-Free
Fax
Service
•
•
•
•
Includes OUTBOUND and INBOUND faxing
Includes 1 TOLL-FREE inbound phone number
Additional
Phone Lines
SELECT SERVICE
Includes 1 LOCAL inbound telephone number
Includes 300 pages per month
Additional pages billed at 12 cents per page
Includes 225 pages per month
Additional pages billed at 12 cents per page
outbound and 14 cents per page inbound
$50.00
$50.00
____ number of local lines
$10.00
____ number of toll-free lines
$15.00 ea./month
ea./month
Please check one.
Please begin service ASAP
Please begin service on the following date:
Your company’s primary contact for Brightree’s Electronic Fax service:
Name:
Email:
BRIGHTREE LLC
Licensee Company Name (please print legibly)
Signature
Signature
Name Printed
Name (please print legibly)
Title
Phone
Date
Date
INTERNAL USE ONLY
CASE # ______________________
ASSIGNED INBOUND PHONE NUMBER:_______________________________