Resources

Access helpful resources for your
patients and practice.

Program Overview Brochure

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This brochure provides an overview of the support services provided by UDENYCA SolutionsTM. 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.

Enrollment Form

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This form is the first step in enrollment into the Coherus SolutionsTM Program. Please complete this form if you are interested in benefit verification, appeals support, or the co-pay savings program.

Patient Consent Form

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This form may be used to obtain patient consent to disclose personal information in order to enroll into patient access programs.

UDENYCA Sample Claim Form 1450

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The sample claim forms provide an example of how a claim form may look when billing for UDENYCA. The UB-04 (CMS-1450) form should be used in the hospital outpatient site of care.

UDENYCA Sample Claim Form 1500

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The sample claim forms provide an example of how a claim form may look when billing for UDENYCA. The CMS-1500 should be used in the physician office or clinic.

Sample Coding Claim Form (CMS 1450) for ONBODY

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The sample claim form provides an example of how a claim form may look when billing for the ONBODY. The UB-04 (CMS-1450) form should be used in the hospital outpatient site of care.

Sample Coding Claim Form (CMS 1500) for ONBODY

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The sample claim form provides an example of how a claim form may look when billing for the ONBODY. The CMS-1500 should be used in the physician office or clinic.

UDENYCA Coding Flashcard

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This coding guide provides overview of the billing codes associated with UDENYCA that may help you submit health insurance claims. This coding guide does not guarantee payment for UDENYCA. Please check with the payer to confirm the appropriate codes and any treatment approval requirements.

Product Fact Sheet Prefilled Syringe

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This fact sheet provides a snapshot of important information related to UDENYCA including ordering and package information and coding and billing information.

Product Fact Sheet Autoinjector

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This fact sheet provides a snapshot of important information related to UDENYCA including ordering and package information and coding and billing information.

Product Fact Sheet ONBODY

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This fact sheet provides a snapshot of important information related to UDENYCA including ordering and package information and coding and billing information.

Product Fact Sheet: All 3 presentations

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This fact sheet includes all 3 UDENYCA presentations. It contains important information related to ordering, coding and billing.

Letter of Medical Necessity

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Prior to utilizing UDENYCA, 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.

Letter of Appeals

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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.

Foundations and other Resources (Alternative Funding)

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This guide provides an overview of foundations and other related organizations offering various types of information and support.