2013 Patient Assistance and Reimbursement Guide - Association of ...

PAP Flow Chart
Step 1 Step 2 Step 3
Provider writes
chemotherapy order
for patient.
Chemotherapy order
is sent to finance staff.
Staff identifies the patient’s
financial status and follows the
appropriate flow chart below.
20
s s s s s s s s s
No insurance
Medicaid Program
Medicare Only
Medicare & Supplemental
Medicare & Secondary
Medicare Advantage
Other Government Programs
Managed Care
Commercial
Identify if patient
qualifies for any programs
(SSDI, Medicaid,
etc.). Identify if
replacement drugs are
available.
Verify benefits.
Verify benefits.
Verify benefits.
Verify benefits.
Verify benefits.
Verify benefits.
Verify benefits.
Verify benefits.
Fill out forms for all
programs. Complete
forms for companies
that have a replacement
program if
patient qualifies.
Verify drugs are
indicated for dx
and authorize if
necessary.
Verify drugs are
indicated for dx.
Verify drugs are
indicated for dx.
Verify drugs are
indicated for dx
and authorize
secondary insurance
if necessary.
Verify drugs are
indicated for dx
and authorize if
necessary.
Verify drugs are
indicated for dx
and authorize if
necessary.
Verify drugs are
indicated for dx
and authorize if
necessary.
Verify drugs are
indicated for dx
and authorize if
necessary.
Identify if foundation
funding is available
for anything not able
to get replaced.
Identify if replacement
drugs are
available if necessary.
Will need to appeal
to receive drugs.
Identify if replacement
drugs are
available if necessary.
Will need to appeal
to receive drugs.
Identify if replacement
drugs are
available if necessary.
Will need to appeal
to receive drugs.
Identify if replacement
drugs are
available if necessary.
Will need to appeal
to receive drugs.
Identify if replacement
drugs are
available if necessary.
Will need to appeal
to receive drugs.
Identify if replacement
drugs are
available if necessary.
Will need to appeal
to receive drugs.
Identify if replacement
drugs are
available if necessary.
Will need to appeal
to receive drugs.
Identify if replacement
drugs are
available if necessary.
Will need to appeal
to receive drugs.
Fill out forms for
foundation funding
that is available.
Identify patient’s
responsibility.
Identify patient’s
responsibility.
Identify patient’s
responsibility and
if there is none start
treatment.
Identify patient’s
responsibility.
Identify patient’s
responsibility.
Identify patient’s
responsibility.
Identify patient’s
responsibility.
Identify patient’s
responsibility.
ACCC 2013 Patient Assistance and Reimbursement Guide