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 that the patient must meet
• 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

After the benefit verification is complete, the ARS reimbursement specialist will fax to you 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

Once the healthcare provider submits the request for prior authorization the reimbursement specialist will:

• 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