Claims Submission
The guidelines for submitting claims will vary based on the setting of care in which SYNVISC® is given. Physicians who administer SYNVISC in an office setting will bill Medicare and most other payers using the Blank CMS 1500 Claim Form (PDF, 87K). Hospitals that administer SYNVISC in the hospital outpatient setting will bill Medicare using the Blank CMS-1450 or UB-92 Claim Form (PDF, 17K).
For billing instructions:
Download the Sample CMS 1500 Claim Form (PDF, 225K) and the Sample CMS-1450 or UB-92 Claim Form (PDF, 15K).
It is important to verify your patients' unique coverage and access requirements before administering SYNVISC. For example, some payers may request additional information to confirm that SYNVISC therapy is appropriate for the patient's medical condition. This is referred to as prior authorization.
For assistance with insurance verifications, understanding prior authorization requirements, and claims support, you may contact SYNVISC ConnectionSM at 1-800-982-8292, M-F, 9am-6pm (EST).
Claims Resubmission and Appeals
In some cases, claims may be denied or pended for additional information.
Often, this is due to coding errors. In some instances, however, claims are denied as the result of inadequate prior authorization, including:
- Medical necessity was not justified.
Download our Sample Medical Necessity Letter (Word, 31K) to provide written confirmation of the patient's condition.
- Patient-specific benefits were limited or had been exhausted.
- Prior authorization was required, but not obtained.
- Required referrals were not received.
To file an appeal, use our Sample Appeal Letter (Word, 42K).
SYNVISC Connection can help you confirm prior authorization requirements, review your claims for proper coding, and resubmit or appeal denials when necessary.
Call 1-800-982-8292, M-F, 9am-6pm (EST).