Q&A on ARS Billing and Claims Support
Q. What is billing and claims support?
A. ARS reimbursement specialists can identify payer-specific coding and claims submission requirements as part of performing a verification of the patient's insurance benefits for Lexiscan. ARS can also review a claim form before submission to a payer to ensure it is complete and help track claims at the payer and communicate the status to the healthcare provider.
Q. Why should I use ARS for billing or claims-submission support?
A. ARS is staffed with experienced reimbursement specialists who can support healthcare providers regarding coverage, coding, and payment for Lexiscan and other Astellas products.
ARS specialists are assigned to a specific geographic region in the United States and are familiar with Lexiscan reimbursement through payers at both a national and regional level. Research on coding guidelines and claims submission requirements with specific payers can expedite the claims filing process and help to minimize payment delays or claim denials.
Q. Can I get more information about specific coding for Lexiscan?
A. Yes. ARS offers educational materials to healthcare providers on appropriate coding for Lexiscan and associated professional services, including:
- Current Procedural Terminology (CPT)* procedure codes
- Healthcare Common Procedure Coding System (HCPCS) codes
- National Drug Codes
- Payer-specific guidelines for coding (ICD-9 diagnosis and procedure codes, revenue codes, and other applicable codes)
For information on coding for Lexiscan, please download a copy of the Quarterly Coding and Billing Reference Sheet. Information and materials provided by ARS are to assist healthcare providers, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider.
Q. How can I request billing and claims submissions support for a specific payer?
A. Healthcare providers can call ARS at
ARS no longer requires providers to submit a signed HIPAA form with requests. We do require you to certify that you understand and will comply with all applicable state and federal patient privacy laws (including but not limited to the HIPAA Privacy Rule) and indicate that you have the patient's written consent on file to share this information with Astellas Reimbursement ServicesSM. ARS may request this consent and if so, you will need to provide such patient's written consent to Astellas Reimbursement ServicesSM upon request. If you need a copy of a Patient Authorization to Disclose Health Information Form (HIPAA Form), you may download one.
Q. I am a pharmacist. Can I contact ARS for billing or claims-submission support for Lexiscan?
A. Absolutely. ARS is able to support healthcare providers across all sites of care.
Q. Why does ARS request personal information about patients such as date of birth and diagnosis?
A. Since coverage, coding, and claims filing processes can vary widely depending on the patient's plan (even for 2 patients with the same insurance company), patient-specific benefit verifications provide the most accurate information for healthcare providers.
ARS no longer requires providers to submit a signed HIPAA form with requests. We do require you to certify that you understand and will comply with all applicable state and federal patient privacy laws (including but not limited to the HIPAA Privacy Rule) and indicate that you have the patient's written consent on file to share this information with Astellas Reimbursement ServicesSM. ARS may request this consent and if so, you will need to provide such patient's written consent to Astellas Reimbursement ServicesSM upon request. If you need a copy of a Patient Authorization to Disclose Health Information Form (HIPAA Form), you may download one.
Q. Can Astellas Reimbursement ServicesSM (ARS) reimbursement specialists tell me how much I should be charging or billing for Lexiscan or a competitor product?
A. No. ARS reimbursement specialists cannot discuss or provide guidance on how much to bill for Lexiscan. ARS specialists also cannot discuss the reimbursement status, codes, or rates for other non-Astellas medications, or compare payment rates for Astellas products and competitive products. Information and materials provided by ARS are to assist healthcare providers, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider.
*Current Procedural Terminology (CPT), Professional Edition, 2011. American Medical Association, 2010. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no responsibility for the data contained herein. CPT is a registered trademark of the American Medical Association.
