Hospital outpatient department
If a patient is denied coverage for NUCALA, Gateway to NUCALA is available to research instances of coverage denial and identify steps practices can take to appeal claims. Gateway to NUCALA cannot author appeal letters on behalf of physicians. See sample letter of appeal below.
When NUCALA is accessed throughout the patient treatment journey, a practice or hospital outpatient department may encounter the need for information on Centers for Medicare & Medicaid Services (CMS) Claim Forms 1500 and 1450, as well as appeal letters and letters of medical necessity. Details and examples of each are provided below.
The sample CMS 1500 claim form will illustrate the information generally required of physician offices by payers.
The sample CMS 1450 form will illustrate the information generally required of hospital outpatient offices by payers.
The sample Letter of Appeal will detail the information needed when appealing a denial of coverage for NUCALA.
The sample Letter of Medical Necessity will explain the medical rationale for choosing NUCALA on a patient-specific basis.
The decision by a payer to pay for a specific product is based on many factors. It is always the prescriber’s responsibility to determine the appropriate treatment and submit appropriate codes, charges, and modifiers for treatments provided. Providers should contact third-party payers for specific information on their policies.