Q. What is billing and claims assistance?
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 VIBATIV. 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 assistance?
A. ARS is staffed with experienced reimbursement specialists who dedicate their time to understanding coverage, coding, and payment for VIBATIV and other Astellas products. They are experts in working with healthcare providers and patients to facilitate access to VIBATIV.
ARS specialists are assigned to a specific geographic region in the United States and are familiar with VIBATIV 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 VIBATIV?
A. Yes. ARS offers educational materials to healthcare providers on appropriate coding for VIBATIV and associated professional services, including:
- Current Procedural Terminology (CPT)a procedure codes
- Healthcare Common Procedure Coding System (HCPCS) codes
- National Drug Codes (NDCs)
- Payer-specific guidelines for coding (ICD-9-CM diagnosis and procedure codes, revenue codes, and other applicable codes)
For information on coding for VIBATIV, 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 assistance for a specific payer?
A. Healthcare providers can call ARS at 1-800-477-6472 to speak with a reimbursement specialist between 9 am and 8 pm ET, Monday-Friday. To expedite requests for payer-specific coding guidelines, healthcare providers may fax a completed Benefit Verification Request Form to ARS at 1-866-317-6235. A patient-specific Summary of Benefits will be faxed to the healthcare provider within 2 business days.
Please note that ARS requires patient authorization before conducting patient-specific insurance research. Providers can have their patient sign their internal HIPAA authorization form and fax a copy to ARS, or they can request a blank HIPAA authorization form from ARS to sign and return. A blank authorization form can also be downloaded and printed from the Forms and Documents section for patient signature and faxed to ARS to indicate patient consent to disclose health information.
Q. I am a pharmacist. Can I contact ARS for billing or claims-submission assistance for VIBATIV?
A. Absolutely. ARS is able to assist 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 only uses patient-specific information for the purpose of verifying an individual’s insurance coverage for VIBATIV. ARS requires that healthcare providers send a HIPAA form with the patient’s signature before initiating reimbursement research on behalf of that individual patient.
Q. Can Astellas Reimbursement ServicesSM (ARS) reimbursement specialists tell me how much I should be charging or billing for VIBATIV or a competitor product?
A. No. ARS reimbursement specialists cannot discuss or provide guidance on how much to bill for VIBATIV. ARS specialists also cannot discuss the reimbursement status, codes, or rates for 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.
a Current Procedural Terminology (CPT), Professional Edition, 2009. American Medical Association, 2008. 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.
