The Merck Access Program (MAP) can contact insurers to obtain coverage and beneﬁts information.
If a prior authorization is required, or for assistance in understanding if a prior authorization is required, MAP may be able to help.
The prior authorization checklist and sample letter below can help you to understand the documents and information that may be helpful when
seeking a prior authorization. As always, you should check for payer-speciﬁc requirements.
If you have submitted a claim and the claim has been denied, you can submit an appeal to your patient’s insurer.
MAP may be able to help your office understand the information needed for an appeal submission.
The appeal checklist and sample appeal letter below can help you to understand the documents and information that may be helpful when filing
an appeal. As always, you should check for payer-speciﬁc requirements.
Getting started is simple
For patient-specific coverage questions
The information available here is compiled from sources believed to be accurate, but Merck makes no representation that it is accurate. This
information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer
as to payer-speciﬁc requirements.
The information available here is not intended to be deﬁnitive or exhaustive, and is not intended to replace the guidance of a qualiﬁed professional
advisor. Merck and its agents make no warranties or guarantees, express or implied, concerning the accuracy or appropriateness of this
information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee
payment or that any payment received will cover your costs.
You are solely responsible for determining the appropriate codes and for any action you take in billing. Information about HCPCS codes is based
on guidance issued by the Centers for Medicare & Medicaid Services applicable to Medicare Part B and may not apply to other public or private
payers. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code
and for information on additional codes. Diagnosis codes should be selected only by a health care professional.