This brochure provides an overview of the support services provided by CIMERLI Solutions™. There is information regarding the co-pay savings program, the patient assistance program, the field reimbursement managers as well as the billing and reimbursement support available.
This form is the first step in enrollment into the CIMERLI Solutions™ program, part of Coherus Solutions™. Please complete for benefit verification, application to the co-pay savings programs, application to the patient, assistance program (PAP) or appeals support.
This coding flashcard providing an overview of the billing codes associated with CIMERLI® that may help you submit health insurance claims. This coding guide does not guarantee payment for CIMERLI®. Please check with the payer to confirm the appropriate codes and any treatment approval requirements.
The sample claim forms provide an example of how a claim form may look when billing for CIMERLI®. The CMS-1500 should be used in the physician office or clinic.
The sample claim forms provide an example of how a claim form may look when billing for CIMERLI®. The UB-04 (CMS-1450) form should be used in the hospital outpatient site of care.
This guide provides detailed information regarding the coding of CIMERLI® by indication. This coding guide does not guarantee payment for CIMERLI®. Please check with the payer to confirm the appropriate codes and any trea™ent approval
This fact sheet provides a snapshot of important information related to CIMERLI® including ordering and package information and coding and billing information.
Prior to utilizing CIMERLI®, the payer may require a prior authorization or a letter of medical necessity. This is a sample letter of medical necessity that may be used as a guide.
The letter of medical appeal may be helpful if you have received a denial from your patient's health insurance. Please review to determine what information should be included in an appeal.
This form needs to be completed in order to request product through the product replacement program. Please see the Product Replacement Guidelines to understand program requirements.
This document reviews the eligibility requirements for the product replacement program and explains how the program works.
Please use this form to request additional product through the patient assistance program for a specific patient if that patient is already enrolled and utilizing the program.
Please use this form to request payment from the co-pay savings program to ensure payment is made through a virtual debit card.