Specialty pharmacies are typically responsible for billing the insurance provider for the cost of SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use (CIII). The healthcare provider (HCP) office should only submit a claim to the insurance provider for the medical services.
Step 1: Submit the claim form
Following administration of SUBLOCADE to the patient, submit a claim to the patient's insurance provider. INSUPPORT can provide you with billing and coding information.
Step 2: Reimbursement
If the claim is approved, the patient's insurance provider should make the payment to the HCP office.
Addressing claim denials
A: Identify the reason for the claim denial
If your claim is denied by the patient's insurance provider, you will be notified of the denial reason by the insurance provider.
Some of the common reasons for denial include:
- Incomplete or inaccurate information
- Lack of prior authorization
- Diagnosis and procedure coding errors and omissions
- Insufficient medical necessity
B: Fix any errors and provide additional documentation
If required, verify coding and other information provided is complete and accurate. You may also submit a Letter of Medical Necessity to the patient's insurance provider, if required by the insurer.
View Sample Letter of Medical Necessity*
*This sample is intended for informational purposes only and not for direct use as a Letter of Medical Necessity.
Do I need to complete the INSUPPORT Patient Enrollment Form again to receive Appeals Information for a denied claim?
For patients already enrolled in "Benefit Coverage Information" with INSUPPORT, appeals information can be provided, where applicable, and does not require a new enrollment. Please contact INSUPPORT for more information.