Navigate managed care roadblocks and secure patient access to therapy
Upon program enrollment, we initiate a benefits investigation to verify the patient’s eligibility prior to billing through our real-time benefits investigation process. Status and results are communicated to patients, caregivers and healthcare providers utilizing portals, email, fax and telephone.
If a prior authorization is required, we will submit payer-specific forms, electronically filed in our system, to facilitate the process with the physician’s office. If an appeal is required, we will initiate and coordinate the appropriate response - up to three levels of appeals. Once prior authorization is received, we communicate this information back to the patient and the healthcare provider.
We perform multiple levels of appeals depending on program needs. We provide physician and/or patient with the payer-specific forms and have the expertise to review clinical documentation as well as support advanced level appeals. All outcomes are communicated to the patient and/or healthcare provider in a timely manner.
For Medicare patients who would benefit from a Part D plan and for patients who qualify as a “hardship” case, we help them obtain insurance through the exchanges by identifying health plans that include coverage for their medications. We present plan options from which they can chose, saving them critical time in trying to make sense of insurance coverage on their own.
Alternate coverage research provides a deep dive into health insurance coverage for patients who have been identified as under-insured or uninsured. Using this research, we identify insurance plans for the patient and send the request to the selected organization to purchase the benefit coverage if the patient is unable to afford the premium. We also work with a variety of organizations that can help provide program and disease resources to patients as well as financial assistance.
Our Patient Services Center specialists will identify and resolve any inquiries associated with billing questions, coding errors and form completion. We conduct educational calls to the physician’s office to resolve any errors in claims processing as a result of incorrect coding or errors in billing. We assist the physician’s office in resubmitting the claim back to the payer for correct billing and aggregate the data on common claims errors to report back to the manufacturer.
Our call center offers robust capabilities to support patients and providers starting in enrollment and throughout their treatment plan. With multilingual capabilities, after-hours support and an unwavering commitment to service, you can rest assured that we have the solutions needed to help you meet your performance metrics.
Our online portal makes it easy to enroll multiple patients in our patient support programs at one time. Additionally, for manufacturers with rebate programs for multiple drugs, our multi-enrollment user portal streamlines the process of enrolling patients across therapies.
Learn how we can create opportunities for you by navigating managed care roadblocks.972.350.9600