Reimbursement

REIMBURSEMENT FORMS

Help with prior authorization and appeals

A detailed Letter of Medical Necessity (LMN) included in an appeal packet may help with a prior authorization (PA). Among the available tools is an Appeals Template that may assist with prior authorization or claims denials. Please see the LMN Template for examples of the types of information that may be applicable. For further assistance, download the Reimbursement Guide, ask your representative, or call 1-866-ARISTADA (1-866-274-7823).

Letter of Medical Necessity Template to support prior authorization/formulary exception request for ARISTADA

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Appeals Template for ARISTADA

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Reimbursement Guide

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Medicare Exceptions and Appeals Guide

Review the process defined by Medicare for appeals of both Original Medicare and Part D coverage decisions.

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