Your partner in navigating patient access and reimbursement
Our Case Managers are experts in navigating the access space. They'll provide the information you need to get your patients started as quickly as possible.
Benefits investigation
Case Managers will perform a benefits investigation to assess your patient’s health insurance coverage, estimate their out-of-pocket expenses, and determine if they qualify for any financial support. Once they verify your patient's coverage, they will:
Learn more about your patient's specific health insurance requirements, such as benefits structure, coverage criteria, appeals and medical exceptions processes, and reimbursement guidance
Give your patient a call to review their summary of benefits and discuss financial support options
Help you navigate prior authorizations (PAs)
You'll have help identifying PA requirements, navigating the PA and/or appeals submission process, and tracking progress. Below are sample letter templates that you can use if your patient’s insurance company needs more information.
Partner with you through the claims submission process
Our Case Managers can serve as a resource throughout the claims submission process. They can assist with denied claims by reviewing the reasons behind the denial and offering guidance on specific payor requirements.
How to submit medical claims
Submit primary claims to the patient’s medical benefit insurance per your normal process. For secondary claims for copay assistance, you can either:
1
Upload claims documentation to CareASSIST
Please include the CMS 1500 or UB-04 claim form along with a copy of the patient's primary insurance explanation of benefits (EOB) showing the out-of-pocket costs for SARCLISA ESCENA and SARCLISA. Documentation must also include the CPT/J-Code, NDC, and/or drug name.
2
Submit an ANSI ASC X12N electronic claim through your medical billing software
Use Payer ID #56155, Group #00003674 (for CareASSIST) as the secondary payor.
Please include the patient’s Copay Program Member ID.
Note: For submission of pharmacy claims, use patient's Rx insurance for the primary claim. For the secondary claim, process a COB claim to PDMI under BIN #610020. If you have any questions or issues with submitting the claim, please call 1-844-322-9286.
Billing and coding
Case Managers are available to offer guidance on billing and coding for SARCLISA ESCENA and SARCLISA. You can also use the below resources to support you as you navigate payor forms and reimbursement submissions.
entrance
Welcome to CareASSIST®
A patient support program by Sanofi
Which describes you best?
