This brief form, once completed, gives Access 360 the ability to provide select services to you. Available in English and Spanish. The Access 360 General Patient Authorization Form must be signed for you to utilize Access 360 support.
Fill this form out to receive assistance from Access 360 for your FLUMIST QUADRIVALENT prescription. The Access 360 General Patient Authorization Form must be signed for you to utilize Access 360 support.
Checklists designed to be used as a reference during the prior authorization (PA) and denial/appeal processes.
This piece provides an overview of the benefit investigation conducted by Access 360.
This brochure explains Medicare Parts A, B, C, and D, key terms commonly used, and prescription coverage within Medicare Part D. It also provides an overview of the current Medicare Coverage Gap (Donut Hole).
This guide provides you with resources and information to ensure you have all the tools you need to help navigate the denial of an AstraZeneca medicine.
This guide provides you with information to help navigate the Access 360 HCP Portal.
Use this guide when completing the CMS-1500 and UB-04 forms to ensure information is filled out correctly before submitting the claim.
This template is offered as a resource a healthcare provider could use when responding to a request from a patient’s insurance company to provide a letter of medical necessity for prescribing AstraZeneca specialty medicines.
This template can be used by a healthcare provider to appeal a denial of access to an AstraZeneca medicine.
Use of these resources does not guarantee that the insurance company will provide reimbursement for AstraZeneca or MedImmune medicines, and is not intended to be a substitute for or an influence on the independent medical judgment of the healthcare provider.