Benefit Verifications Q&A
Q. What is this service and how does it work?
A. Astellas Reimbursement ServicesSM (ARS) has reimbursement specialists experienced in verifying insurance coverage requirements for Vaprisol. Healthcare providers can submit a Benefit Verification Request via Astellas eService to ARS. An ARS reimbursement specialist will contact the patient's insurance company within one business day to research their coverage for Vaprisol, including the process for prior authorization if needed, patient cost share, and other coverage and access details. Then, ARS will provide the healthcare provider a Summary of Benefits detailing all of the coverage information obtained from the patient's insurance company.
Q. Do I have to submit a Benefit Verification Request on Astellas eService for each of my patients who require Vaprisol?
A. No, but the benefit of doing that is that each patient is likely to have differences in their coverage (even patients with the same plan or employer can have different coverage). Researching coverage, coding, and reimbursement information on a patient-specific basis will give you the most comprehensive information so your patients will have access to the medication that has been prescribed.
Q. What is the value of asking ARS to do a benefit investigation prior to providing cardiology medications?
A. By asking ARS to conduct a benefit investigation, the patient and provider may:
- Receive verification that the patient has coverage for Vaprisol, as applicable
- Identify if there are any utilization restrictions such as prior authorization that, if not addressed proactively, could impede patient access to the medication
- Understand the patient's cost share obligations so that any access issues are identified
Q. Can ARS secure prior authorization on the patient's behalf?
A. ARS cannot submit the prior authorization request on behalf of a healthcare provider. ARS can:
- Support your practice or facility through every step of the prior authorization process
- Provide contact information for submission of the prior authorization request (phone, fax, or mailing address)
- Determine what information is needed to support medical necessity, report payer's decision turnaround time, and confirm how the site will be notified of the outcome by the payer
- Provide any payer-specific Prior Authorization forms and a template letter of medical necessity for customization by the healthcare provider
- Call the payer to check on the status of the prior authorization and follow up with the practice or facility to communicate the status
Q. How does ARS handle sensitive patient information?
A. 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, you may download one.
Privacy laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require that a patient's written authorization be obtained before identifiable health information may be disclosed to or received by ARS.
Patient's personally identifiable information (PII) or protected health information (PHI) is handled and collected in strict accordance with all applicable laws.
