The most common reasons for Neulasta® (pegfilgrastim) claims denials may include:

• misspellings and transposed numbers
• improper use of CPT®* or HCPCS codes
• inadequate description of products or services provided
• restrictions on coverage settings or benefit contracts
• delayed claim filing

In the event of a claim denial, be sure to resubmit the claim promptly and with appropriate documentation. Well documented follow-up submissions are often successful.

It also is important to determine the specific information required to resubmit the claim by speaking with the appropriate claims examiners and provider relations contacts at the insurance company.

Many times claims are denied because the claims examiner may be unfamiliar with the therapy. Other times, the medical necessity of the therapy may not be readily apparent. When resubmitting a denied claim, it is helpful to include the following documentation:

• a letter of medical necessity
• a copy of the package insert
• reprints of journal articles that support the efficacy of Neulasta® used for the indication in question

The Reimbursement Connection® is prepared to work with your patients' insurers to help research claims denials and provide guidance to you regarding resubmission of claims, where appropriate. Additionally, Amgen's Reimbursement Connection® can put you in contact with our Medical Information Connection™ team so that you can obtain copies of clinical information, including peer-reviewed journal articles.

*CPT® five-digit codes, nomenclature, and other data are ©2005 American Medical Association. All rights reserved. No fee schedules, basic unit, relative values, or related listings are included in CPT®. The AMA assumes no liability for the data contained herein.