Forms

Denied Claims Appeals Resources

Update your billing and coding systems to include the permanent CYRAMZA® (ramucirumab) J-code: J9308, injection, ramucirumab, 5 mg. Issued by the Centers for Medicare & Medicaid Services (CMS), this permanent J-code is effective as of January 1, 2016.

Forms

Denied Claims Appeals Resources

Find the resources you need to navigate the appeals process.

If an insurance claim is denied, Lilly PatientOne can work with you and provide resources to help you file an appeal on your patient’s behalf. We’ll help you understand what documents and information you’ll need and the deadlines you’ll have to meet to have the best chance for a successful outcome.

If you have questions about filing an appeal, please call us at 1-866-4PatOne (1-866-472-8663).

Lilly PatientOne Application Denied Claims Appeals Resources

Denied claims checklist

If a patient receives a denied explanation of benefits or an unfavorable response to a previous appeal, use this checklist to help you prepare an appeal packet.

Letter of medical necessity information

This guide provides important information needed in your letter of medical necessity to help facilitate the appeal process.

First-level appeal letter for commercial or other insurance

Use this template to create a request letter for a first-level appeal by an oncology medical adviser.

Second-level appeal letter for commercial or other insurance

If your patient’s first appeal was denied or he/she received an unfavorable response, use this letter template to initiate a second-level appeal.

First-level Medicare review letter

If your patient has been denied Medicare coverage, this letter template will help you request a redetermination by an oncology medical adviser.

Second-level Medicare review letter

If your patient’s first Medicare review resulted in a denial or an unfavorable response, use this letter template to initiate a second-level review.