Why is a benefits investigation important?
Herceptin Access Solutions conducts a benefits investigation (BI) to
help you better understand your patient's health insurance plan
coverage for some or all of the costs associated with treatment. The
BI can also determine if a prior authorization (PA) or patient
assistance might be needed.
There are 3 possible outcomes of a BI:
- Treatment is covered
- PA is required
- Treatment is denied
To begin with Herceptin Access Solutions, you must complete and submit a Statement of Medical Necessity (SMN) form and have your patient complete and submit a Patient Authorization and Notice of Release of Information (PAN) form. To request a BI, be sure to check the appropriate box on the SMN.
This description of a BI is for informational purposes only.
Herceptin Access Solutions makes no representation or guarantee
concerning reimbursement or coverage for any service or item.
Herceptin Access Solutions can help your practice identify ifwhether
a prior authorization (PA) is needed and offer support as you obtainin
the process of securing it for your patient.. All we need to begin are
a completed and signed Statement of Medical Necessity (SMN) form
requesting our assistance with the PA as well as a signed and dated
Patient Authorization and Notice of Release of Information (PAN)
Herceptin Access Solutions can help you as you submit the required PA
forms and documentation. If the PA is not granted, Herceptin Access
Solutions can work with you to determine your next steps. Tips like
this can be found in Forms