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Navigating Additional Payer Challenges

These downloadable flash cards provide potential examples of other ancillary insurance issues you and your patients may encounter after you prescribe EYLEA® (aflibercept) Injection.

Start Here: Decision Tree

A guide to help determine whether a patient has a Medicare ID card or private insurance card.

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Ancillary Flash Cards

Help Understanding ERISA

Information to help you begin to navigate potential reimbursement questions with ERISA-related claims.

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Help Understanding Medicare Part B Fee-for-Service

Potential examples of EYLEA claim questions and applicable provisions for patients with Medicare Part B Fee-for-Service.

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Help Understanding Medicare Fee-for-Service Audits

Potential examples of scenarios regarding questions that may occur when Medicare conducts audits of providers who bill fee-for-service programs.

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Help Understanding Medicare Advantage Plan/HMO

Potential examples of claim questions that providers and administrators may encounter after prescribing EYLEA for patients with Medicare Advantage.

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Help Understanding Medicare Advantage Step Therapy

A guide for navigating step therapy with EYLEA for patients with Medicare Advantage plans.

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Help Understanding the Medicare Appeals Process

Potential examples of questions providers and administrators may encounter when appealing EYLEA through Medicare Part B and Part C.

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Help Understanding Skilled Nursing Facilities (SNFs)

Potential examples of SNF-related reimbursement questions providers and administrators may encounter after prescribing EYLEA.

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This material is provided for informational purposes only, is subject to change, and should not be construed as legal or medical advice. Use of this information to challenge or appeal a coverage or reimbursement delay and/or denial by a payer is the responsibility of the provider.

Reimbursement Time Frames

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Gold Card Act Legislation

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ERISA = Employee Retirement Income Security Act; HMO = health maintenance organization; ID = Identification.

This material is provided for informational purposes only, is subject to change, and should not be construed as legal or medical advice. Use of this information to challenge or appeal a coverage or reimbursement delay and/or denial by a payer is the responsibility of the provider.