coding & Reimbursement

Your step-by-step guide to CIMERLI^® reimbursement

Reimbursement Process

Medical Claims Submission: Providers

There are three ways for a provider to submit claims for reimbursement to the Co-Pay Assistance Program:

Electronically (click to learn more)

Electronic secondary payer billing (ESP billing) allows CIMERLI^® co-pay claims to be submitted and processed like a secondary payer for both drug injection administration benefits, per eligibility criteria.

Method	Manually
	Submit required documentation to: TrialCard 2250 Perimeter Park Drive, Suite 300 Morrisville, NC 27560
	or via fax: 1-888-481-0544
	Please ensure the claim documentation clearly states the CPT/Q-Code, NDC, and/or drug name as well as the remaining out-of-pocket expense for CIMERLI^®.
	Online: Submit claims through SmartData Solutions (SDS) website:
	Register and complete account setup with SDS. Someone from your IT department, claims processing software vendor, or EDI coordinator may be able to help. Navigate to https://quickclaim.smart-data-solutions.com/quickclaim/servlet/quickclaim/ and log in using your supplied credentials. Once you have gained portal access, you can submit the claims for the Coherus Solutions™ Co-Pay Assistance Program via the following means: Direct File Upload to the Portal Manual Claim Entry
	Please ensure the claim documentation clearly states the CPT/Q-Code, NDC, and/or drug name as well as the remaining out-of-pocket expense for CIMERLI™ (ranibizumab-eqrn). FOR CLAIM SUBMISSION FOR VIRTUAL DEBIT CARD REIMBURSEMENT: Please fax the Virtual Debit Card Fax Coversheet* with the required documentation to 1-888-481-0544.	Please ensure the claim documentation clearly states the CPT/Q-Code, NDC, and/or drug name as well as the remaining out-of-pocket expense for CIMERLI^®. FOR CLAIM SUBMISSION FOR VIRTUAL DEBIT CARD REIMBURSEMENT: Please fax the Virtual Debit Card Fax Coversheet* with the required documentation to 1-888-481-0544.

Download The Virtual Debit Card Fax Coversheet

Terms and Conditions

Coherus’ Drug Copay Program and Administration Copay Program are different programs with unique eligibility for each. Patients must enroll separately as needed. To receive co-pay assistance for administration co-pay costs, the provider, patient, or caregiver must enroll eligible individual within 180 days after the date of service for which the subsidy is sought.

Participating patients, pharmacies, physician offices and hospitals may use Coherus’ patient services web portal or send completed enrollment forms to 1-877-226-6370 to enroll patients. Under the program, if a patient incurs a co-pay obligation for the administration of CIMERLI, and meets all eligibility requirements, Coherus shall subsidize the cost of administration up-to $1000 per calendar year. The program benefit will reset every January 1st. Re-enrollment in the program is required at regular intervals. Patients may participate in the program as long as patient re-enrolls as required by Coherus BioSciences and continues to meet all of the program’s eligibility requirements during participation in the program.. After reaching the maximum program benefit, the patient will be responsible for all remaining out-of-pocket expenses. The amount of the program’s benefits cannot exceed the patient’s out-of-pocket expenses for the cost of the drug or administration fees associated with CIMERLI.

The program is not valid if the costs are eligible to be reimbursed in their entirety by private insurance plans or other programs. The program is not valid for patients receiving assistance from any other third party, including charitable organizations, if assistance is for the same expenses covered by the programs. The administration assistance cannot be combined with any other rebate, free trial or similar offer for the medication or administration of the product unless otherwise permitted by Coherus. The program is not health insurance or a benefit plan.

All participants are responsible for reporting the receipt of all program benefits as required by any insurer or by law. The programs are only valid in the United States and U.S. Territories and otherwise void where prohibited by law, including in Minnesota, Rhode Island. *In Massachusetts special conditions apply. The injection administration copay may only be paid directly to the patient. Additional information may be required to facilitate payment directly to the patient. Program benefits may not be sold, purchased, traded or offered for sale.

The programs do not obligate use of any specific product or provider. Healthcare providers may not advertise or otherwise use the programs as a means of promoting their services or Coherus products to patients. Coherus reserves the right to rescind, revoke or amend the program without notice at any time.

	Set-up Coherus Solutions™ in your billing system (only requires set-up once)
	Biller appends Coherus Solutions™ to the claim as a secondary payer after CIMERLI^® is administered
	After payment is received from the primary payer, balance billed to Coherus Solutions™ like a secondary payer
	Claims are electronically routed to Coherus Solutions™ Co-Pay Assistance Program via clearinghouse
	Payment made to provider

Your step-by-step guide to CIMERLI^® reimbursement

Reimbursement Process

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