Required Information For

Processing an order

On the order form, please list all contact numbers for the patient under the Patient Demographics section. Be sure to select the 72-HR Length of Monitoring box in the Order section of the order form.

Make sure that the ordering provider has signed his or her name in the Ordering Healthcare Provider section.

Provide a copy of the front and back of the patient’s insurance card (or patient demographics face sheet).

Provide the most recent clinical notes and complete medication list that directly support the selected ICD-10 code(s) so that NeuLine can verify and authorize the patient’s insurance.

Include the documentation and the report from the most recent routine EEG test (if applicable).

EEG Testing Ordering Workflow

The patient fills out the Brain Wellness Intake Form.

If the form yields any “Y” responses, the patient may meet the criteria for an EEG test.

Complete the NeuLine Order Form and submit with medical record—clinical notes, complete medication list, and patient demographics (including front and back of insurance card if possible).