DMEPOS Providers Business Capabilities Survey

DMEPOS Providers Business Capabilities Survey
What is the name of your company? *
Please enter the addresses of your company's retail locations. Use the "+" button if there are multiple locations *
What is your company's TIN #? *
Please select the member of your team who will act as the primary operational or strategic lead that manages engagement with Tomorrow Health. Include that team member's full name below. *

First Name Last Name
What is their email address? *
example@example.com
What is their phone number?

Area Code Phone Number
What is their specific phone number extension?
Leave blank if no extension is necessary
Does your organization have an after-hours phone number for urgent orders?

Area Code Phone Number
With which of the following insurance plans is your company contracted? Note: This may apply to GHP members with potential secondary coverage. (Select all that apply) *

Geisinger Health Plan - Gold Geisinger Health Plan - Family Geisinger Health Plan - Kids Geisinger Health Plan - Marketplace Medicare Pennsylvania Medicaid ACCESS Highmark Independence Blue Cross AmeriHealth Caritas (CHC) PA Health & Wellness KeystoneFirst CHC UPMC Community HealthChoices Geisinger Health Plan - Gold Secure DMEnsion Humana
Do you have in-house delivery drivers for each of your retail locations? *

Yes, we support same day deliveries Yes, we support next day deliveries We do not have in-house drivers
If applicable, please upload a spreadsheet that reflects the PA Counties that your team of in-house delivery drivers can serve for each of your individual retail locations. Please further notate those counties serviceable for same-day delivery for each individual retail location.

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Note: This file must be submitted in Microsoft Excel. Cancel of
Do you have the ability to ship a portion of your inventory commercially from each of your company's retail locations? (e.g. USPS, UPS, FedEx, etc.) *

Yes No
Please upload a spreadsheet that includes the following elements: HCPCS capabilities for each of your company's individual retail locations, specification of all product brands you provide by each HCPCS / product serviced, zip codes serviced by each location, and the TIN # for each retail location. *

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Note: This file must be submitted in Microsoft Excel. If HCPCS vary by retail location, please indicate which locations carry which HCPCS. Cancel of
Some DMEPOS providers maintain an onsite supply of equipment & supplies at servicing provider offices, post-acute settings, and hospitals - commonly known as Supply Closets or Consignment. If applicable, please upload a spreadsheet that reflects your Supply Closet relationships for each of your company's individual retail locations. *

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Note: This file must be completed in Microsoft Excel. Cancel of
Tomorrow Health uses a platform called Box to send orders your way. DME supplier team members are provided with Box access so that they can accept orders we send them. Who are the members of your intake team that will directly manage orders from Tomorrow health? Please include both full names and email address below. (Don't worry, you can always edit/expand this user list later! For now, please include the most critical team members) *
As the final step in onboarding, Tomorrow Health sends out a test order in Box to ensure that your organization can receive order notifications. Please select individual from the above list of names who will be responsible for accepting the test order. *

First Name Last Name
In the event that we need to work through resolution of Box set up issues, who is the best IT resource (preferably a lead) for us to contact? Please include that resource's (or resources') full name and email address below. *
As a component of onboarding with Tomorrow Health, we ask that all INN DME suppliers attend a virtual onboarding session to walk through an overview of our partnership with GHP in addition to a demo of Box.

Please register for an onboarding webinar session through the link below: Webinar Registration Link
Please confirm that you selected a time to attend an onboarding session below. *

I confirm that I have registered for an onboarding session using the link provided above.
Go To Webinar Registration Link
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