Bristol-Myers Squibb Access Support® is committed to helping appropriate patients get access to our medications by providing reimbursement support services for healthcare offices.

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Prior Authorization

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.

What You'll Need for Prior Authorization Assistance from BMS Access Support:
  • Completed enrollment form signed by the patient and physician, including:
    • a. patient information
    • b. physician information
    • c. insurance information
    • d. diagnosis and drug name

Prior Authorization Appeals

 

References:
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.

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