Prior Authorization Support Process

1. Healthcare provider submits a Benefit Verification Request via Astellas eService.

ARS no longer requires the healthcare provider to submit a completed HIPAA form. ARS requires the healthcare provider to retain proof of patient signature on file in their office.
2.

ARS reimbursement specialist contacts the payer(s) to verify patient-specific coverage. If the ARS specialist identifies that the payer requires prior authorization, the ARS specialist will also research and provide the following information to the healthcare provider:

  • Detailed guidance for initiating and requesting prior authorization
    • Contact information for submitting the prior authorization request (phone, fax, or mailing address, department name)
  • Medical and clinical criteria requested
    • Information needed to support medical necessity such as chart notes, lab results, medical records, previous therapies and results, current medications
  • Expected turnaround time for Prior Authorization determination at the payer
  • How the site can expect to be notified of the prior authorization determination by the payer
  • Length of time or number of treatments covered by the prior authorization, if approved
  • Claim submission instructions from the payer, if applicable, once prior authorization is obtained
3.

After the benefit verification is complete, the ARS reimbursement specialist will provide you with a comprehensive Summary of Benefits within 2 business days, which may include:

  • A summary of the prior authorization requirements
  • A template letter of medical necessity, which you will need to customize to describe the patient situation
  • Copies of payer-specific prior authorization form(s), if applicable
4. ARS reimbursement specialists are available to the healthcare provider to answer questions about the Summary of Benefits and discuss the prior authorization process.
5.

Once the healthcare provider submits the request to the payer for prior authorization the reimbursement specialist can:

  • Call the payer to track the processing of the prior authorization request until a determination is made
  • Call the healthcare provider with status updates throughout the process


PLEASE SEE INDICATION AND IMPORTANT SAFETY INFORMATION INCLUDING BOXED WARNING HERE.
PLEASE SEE FULL PRESCRIBING INFORMATION HERE.

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