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.
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Method | Manually | |
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Submit required documentation to: TrialCard 2250 Perimeter Park Drive, Suite 300 Morrisville, NC 27560 |
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or via fax: 1-888-481-0544 |
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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).
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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).
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Online: Submit claims through SmartData Solutions
(SDS) website: |
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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
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Set-up Coherus Solutions™ in your billing system (only requires set-up once) |
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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 |
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After payment is received from the primary payer, balance billed to Coherus Solutions™ like a secondary payer |
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Claims are electronically routed to Coherus Solutions™ Co-Pay Assistance Program via clearinghouse |
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Payment made to provider |
For assistance with the Coherus Solutions® Co-Pay Program,
visit the Coherus SolutionsTM Provider Portal.