Bristol-Myers Squibb Access Support® is committed to helping appropriate patients get access to our medications by providing reimbursement support services for healthcare offices.
Enroll, track, and manage your reimbursement cases.
Bristol-Myers Squibb (BMS) Access Support can provide plan-specific prior authorization forms when one is required by the patient's health plan.
Some health insurers require that a prior authorization be issued before certain items or services are covered. This may require specific forms and supporting documents before a prior authorization may be issued (e.g., medical history, physicals, pathology reports, etc.). When necessary, make sure your patients understand coverage for the service before they have a financial obligation to their provider.
Please note: If a prior authorization requirement is not met, some health insurers may deny coverage, even if the claim would have otherwise been covered. If coverage is denied, either the physician or the patient may appeal. See below for details on prior authorization appeals.
Some insurers will make a predetermination of coverage decision upon request. This generally applies to an item or service that does not require a prior authorization. If a predetermination decision denies coverage, either the physician or patient may appeal the decision with the insurer, in the same manner an appeal can be made on a denial of prior authorization.
Both you and your patients can appeal an insurer's decision to deny a prior authorization. Many insurers maintain coverage appeal processes, including a relatively short completion time (for example, 72 hours).
Note for Medicare Part B: Providers must understand Medicare coverage policy. Medicare Part B publishes national and local coverage policies1, and only considers claims for coverage when providers present them to a Medicare Administrative Contractor for payment. If Medicare denies a service as “not reasonable and necessary,” the provider may only bill the patient for the denied service if the provider obtained a signed Advance Beneficiary Notice (ABN) from the patient before the service was provided. Without a properly executed ABN, the provider may not bill the patient for the service denied as “not reasonable and necessary.”2
Find an ABN designed and approved by Centers for Medicare & Medicaid Services for this purpose here.3 This form was created for Medicare Part B and does not apply to Medicare Advantage plans or Medicare Part D, which have their own unique prior authorization and patient notification procedures.4
1. Medpac.gov. An introduction to how Medicare makes coverage decisions. Report to the Congress: Medicare Payment Policy. March 2003. http://www.medpac.gov/publications%5Ccongressional_reports%5CMar03_AppB.pdf . Accessed June 4, 2014.
2. Centers for Medicare & Medicaid Services. Form CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN). http://www.cms.gov/ Medicare/Medicare-General-Information/BNI/Downloads/RevABNManualInstructions.pdf. Accessed June 4, 2014.
3. Centers for Medicare & Medicaid Services. Fee For Service Advance Beneficiary Notice of Noncoverage.http://www.cms.gov/Medicare/ Medicare-General-Information/BNI/ABN.html. Accessed August 6, 2015.
4. Centers for Medicare & Medicaid Services. Form Instructions Advance Beneficiary Notice of Noncoverage (ABN). OMB Approval Number: 0938-0566.2012.
The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol-Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.