astellasreimbursement

The Medicare benefits are administered by insurance companies acting as contractors at a local jurisdiction level. Historically, Medicare contractors have been fiscal intermediaries (FIs), responsible for processing facility claims, and carriers, responsible for processing most outpatient provider claims. Medicare is in the process of transitioning FIs and carriers to Medicare Administrative Contractors (MACs). MACs will consolidate all claim processing responsibilities for facility and non-facility healthcare providers within a single contractor for a geographic region. This transition means that, as a healthcare provider, you may have experienced or may now be experiencing a change in the Medicare contractor that processes your Medicare claims. As a result, you may be working through process or coverage changes within your practice or institution.

The Medicare contractors responsible for developing coverage guidelines and processing claims for services vary by state and by the type of service that is provided. Medicare contractors may publish coverage parameters for Medicare-covered drugs and services in the form of a local coverage determination (LCD) or through other provider communications. It is important to confirm coverage guidelines with your local Medicare contractor to understand any established diagnosis, clinical, or dosing guidelines that may apply to the service being provided to the patient.

For Protopic^® (tacrolimus) Ointment, Medicare Part D plans are administered by private insurance companies contracted to provide Part D benefits to enrolled beneficiaries. Part D plans can be a stand-alone prescription, commonly referred to as a "PDP", or Part D benefits can be part of a comprehensive managed care plan through Medicare Advantage. Medicare Advantage plans that offer part D coverage are often referred to as MA-PDs. Part D claims, whether stand-alone or through Medicare Advantage, are submitted by dispensing pharmacies directly to the insurance company sponsoring the part D coverage. The claim is processed in the same way a private insurance prescription claim is processed. The beneficiaries' out-of-pocket is determined by the type of plan he/she is enrolled. 

Astellas Reimbursement Services^SM is also available to help you understand the changing Medicare contractor environment and the coverage guidelines that may be in place in your state. You can call 1-800-477-6472 for Medicare support from a reimbursement specialist who understands Medicare coverage and claims specific to your geographic location.