Some of our specific reimbursement services include:
TheraCom excels at therapy reimbursement for complex products. We specifically hire professionals with health care backgrounds and have developed highly successful reimbursement programs for some of the world's most complex biotech therapies.
TheraCom pursues a goal of 100 percent coverage for each product we handle. We treat each case individually, but utilize coverage history precedents from our product-specific payer history database whenever appropriate.
We have expertise in developing tailored reimbursement programs that are intended to:
- Substantially increase the likelihood of therapy reimbursement
- Provide personalized billing options for physicians and their patients
- Address specific billing issues associated with the products
- Facilitate communication of insurance coverage information between the prescribing physician, patient and treatment provider
- Identify coverage option that results in lowest out-of-pocket cost to the patient
Some of our specific reimbursement services include:
- Product Coverage, Advocacy, Appeals
- Insurance Verification
- Billing Assistance
- Wholesale Purchase Agreements
- Reimbursement Hotlines
Product Coverage and Advocacy
TheraCom’s focus on specialty products affords broad and deep experience in navigating potential coverage obstacles and overcoming these barriers. We anticipate the types of challenges a new product may face and develop methods to overcome them. Examples of specific actions might include:
- Assisting physicians in completing and filing statements of medical necessity
- Facilitating prior authorization approval
- Assisting the prescribing physician and involving the patient in crafting an appeal where prior authorization is initially denied.
Insurance Verification
Where applicable, TheraCom can bill insurers directly, whether a product is covered through a patient's pharmacy benefit or through the major medical portion of their plan. Electronic adjudication capabilities allow real-time verification of the pharmacy benefit. TheraCom always seeks to obtain coverage that results in the lowest possible out-of-pocket cost to the patient.
Billing Services
TheraCom is a provider of reimbursement services that are integrally coordinated with the specialty pharmacy network. Billing procedures vary by insurance plan, and often differ based on site of administration. TheraCom provides insurance verification for all referred patients and in many cases can bill the insurer directly for the product.
Wholesale Purchase Agreements
Some payers cover specialty pharmaceuticals through the medical benefit and require that the physician who administers the injectable product also bill for the product.
If it is determined that the administering physician must bill for a product as specified by the payer, TheraCom can identify a licensed wholesaler that can sell the product directly to the physician. TheraCom can also then provide coding and billing expertise to streamline the claim submission and payment process on behalf of that physician.
Reimbursement Hotlines
TheraCom's hotline services aid manufacturers in informing physicians about coverage and payment for newly introduced products. Reimbursement Hotlines are a cost-effective resource for manufacturers to answer specific questions that are outside the clinical expertise of pharmaceutical sales representatives (such as those regarding the specifics of billing, coding and coverage policy). Physicians and patients gain access to experienced reimbursement specialists via a toll-free telephone and/or fax. TheraCom’s goal is always to identify coverage that results in the lowest out-of-pocket cost for the patient.