HOW TO INITIATE A CASE

How to Initiate Case Management Services

1. Fill out a Case Management Request Form
2. Remit Payment for $250 to Initiate Service

The first Coordinated Service in each case is billed upfront.

All subsequent Coordinated Services for a case are invoiced upon completion of each service.

How to Remit Payment

1. Use the digital form to remit payment and initiate case management services for a new case, or to request additional services on an existing case.

How to Submit a Case Management Request Form

BioConnetiX offers multiple ways to submit a Case Management Request Form. Choose the option that best fits your workflow.

Option 1: Fully Digital Submission (Recommended)

Digital Form (DocuSign)
Click the link to complete, sign, and submit the Case Management Request Form electronically via DocuSign.
You will automatically receive a copy of the fully executed form for your records.

Option 2: Paper or Manual Submission

If you prefer a paper form or manual process, you may submit the completed Case Management Request Form using any of the following methods:

1. Upload at Checkout: Upload the completed form during the checkout process
2. Fax: Fax the completed form to (469) 599-7188
3. Secure Email: Email the completed form to PHI-Secure@BioConnetiX.com
   

Important Payment Matching Notice

Please enter the Case Number from the form during checkout to ensure your payment is correctly applied to the associated request.