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 UDENYCA® (pegfilgrastim-cbqv) co-pay claims to be submitted and processed like a secondary payer. Electronic secondary payer billing (ESP billing) allows TORELBY™ (toripalimab) co-pay claims to be submitted and processed like a secondary payer.

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 UDENYCA® (pegfilgrastim-cbqv).	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 TORELBY™ (toripalimab).
	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 UDENYCA® (pegfilgrastim-cbqv). 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 TORELBY™ (toripalimab). 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.

For Pharmacy Benefit Claims

• Pharmacies should use patient's prescription insurance for the primary claim.
• Process a Coordination of Benefits (COB) claim to PDMI under BIN 610020 as the secondary claim.

Download The Virtual Debit Card Fax Coversheet

• Patients must be enrolled in the Coherus Solutions™ Co-Pay Assistance Program
• Field Reimbursement Managers can provide staff education on system set-up

	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 UDENYCA® (pegfilgrastim-cbqv) is administered Biller appends Coherus Solutions™ to the claim as a secondary payer after TORELBY™ (toripalimab) 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