Lilly Cares Foundation
The Lilly Cares Foundation, Inc., a separate nonprofit organization, provides free Lilly medicines to qualifying patients. For more information about Lilly Cares, please visit LillyCares.com.Go to Lilly Cares Foundation
Independent Patient Assistance Program Foundations
There may be a way to help your underinsured patients get the treatment they need with less financial stress. If your patients can’t afford their co-pay or coinsurance, Lilly PatientOne provides information about a number of independent patient assistance programs that may be able to help eligible patients.These foundations are not affiliated with Eli Lilly and Company and have been established and are operated independently. Please remember, funding availability changes weekly, so contact a Lilly PatientOne representative at 1-866-4PatOne (1-866-472-8663) for the most recent updates.View Foundation List
Reimbursement ResourcesReimbursement News through Oplinc
Oplinc is a national organization dedicated to preserving patients’ access to cancer services through education and communication among those involved in the delivery of quality cancer care.
CodingAmerican Medical Association: CPT® Current Procedural Terminology
A resource maintained by the CPT Editorial Panel to help you better understand the latest CPT codes and coding issues.HCPCS (Healthcare Common Procedure Coding System) Codes: CMS
The Centers for Medicare & Medicaid Services (CMS) provides a website with coding and process information as well as modifications you should know about.HCPCS Files: CMS
A downloadable PDF with Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data.Place of Service Codes for Professional Claims: CMS
Download the Medicare Claims Processing Manual Chapter 26: Completing and Processing Form CMS-1500 Data Set.ICD-10-CM: Guidelines, Codes, and Descriptions
Details on the diagnosis coding system, ICD-10-CM, developed as a replacement for ICD-9-CM.National Correct Coding Initiative (NCCI): CMS
Downloadable PDFs explaining how to use the National Correct Coding Initiative tools.
CoverageMedicare National and Local Coverage Decisions: CMS
Search and view data from the Medicare Coverage Database, which contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions.
ReimbursementMedicare Physician Fee Schedule (Look Up Allowables by State and Code): CMS
Search by type of information, Healthcare Common Procedure Coding System (HCPCS) Criteria, Carrier/Medicare Administrative Contractor (MAC), and moreMedicare Part B Average Sales Price Drug Pricing Files for Physicians
Manufacturer reporting of Average Sales Price (ASP) data and ASP Drug Pricing Files.Hospital Outpatient Information
Helpful links, resources, and downloads for Hospital Outpatient Prospective System Rulemaking.Medicare Clinical Lab Fee Schedules: CM
Information on the clinical laboratory fee schedule, regulations, notices, citations, and more.
Find the resources you need to navigate the appeals process.
Lilly PatientOne Application and Appeal Resources
If an insurance claim is denied, Lilly PatientOne can provide information to help you file an appeal on your patient’s behalf. We’ll help you understand what documents and information you’ll need and the deadlines you’ll have to meet.
If you have questions about filing an appeal, please call us at 1-866-4PatOne (1-866-472-8663).
Denied claims checklist
If a patient receives a denied explanation of benefits or an unfavorable response to a previous appeal, use this checklist to help you prepare an appeal packet.
Letter of medical necessity information
This guide provides important information needed in your letter of medical necessity to help facilitate the appeal process.
First-level appeal letter for commercial or other insurance
Use this template to create a request letter for a first-level appeal by an oncology medical advisor.
Second-level appeal letter for commercial or other insurance
If your patient’s first appeal was denied or he/she received an unfavorable response, use this letter template to initiate a second-level appeal.
First-level Medicare review letter
If your patient has been denied Medicare coverage, this letter template will help you request a redetermination by an oncology medical advisor.
Second-level Medicare review letter
If your patient’s first Medicare review resulted in a denial or an unfavorable response, use this letter template to initiate a second-level review.