Personalized Support
for Your Patients
Enroll Your Patient
Enrolling your patient in ADVANCING Patient Support is easy. You can either complete and submit the enrollment form online, or you can download the form here and submit via fax or email.
Fax: 1-855-915-3005
Email: [email protected]
If you enroll your patient online, please ask them to fill out and submit the following authorization and consent forms: Patient Authorization | Patient Assistance Program (PAP) Consent
Once enrolled, your patient will receive a welcome call from ADVANCING Patient Support. Have them save 1-855-690-0340 in their contacts so they recognize the number.
Overview of Services
ADVANCING Patient Support offers the following services to assist patients during the treatment process:
Coverage Support
Benefits investigation—enrollment initiates a benefits investigation:
A summary of benefits will be provided to help you and your patient better understand their insurance coverage and out-of-pocket costs.
Prior authorization/precertification:
Helps determine if a prior authorization or precertification is needed for your patient and can provide guidance and support throughout the process.
Appeals/Claims support:
Provides guidance on coding and billing, the appeals process, and can help answer any questions that may arise.
Financial Support
Commercial copay program:
If eligible, your commercially insured patient can be enrolled in the copay program. Your patient may pay as little as $0 per dose.a
Patient Assistance Program:
Your patients who are uninsured or underinsured could receive ZYNLONTA® for free if they meet the criteria for the Patient Assistance Program (PAP).
a For commercially insured patients, 18 years of age and older with coverage for ZYNLONTA®. Patients are not eligible if they participate in any federal or state healthcare program with prescription drug coverage, such as Medicaid, Medicare, Medicare Part D or Medicare Advantage plan, VA, DOD or TRICARE. Excludes patients who are uninsured or full cash-paying. Maximum benefit per patient, per calendar year (1/1-12/31) is $25,000. Additional eligibility requirements and other restrictions apply. Visit ADVANCINGPatientSupport.com/copay-terms-conditions
Frequently Asked Questions
ADVANCING Patient Support is a patient support program from ADC Therapeutics. The program offers personalized assistance for patients being treated with ZYNLONTA®, including assignment of a dedicated case manager, coverage and financial support, as well as nursing support for patients.
For more information, call 1-855-690-0340 to speak with a case manager.
ADVANCING Patient Support offers personalized assistance for patients being treated with ZYNLONTA®.
You can find more information about ZYNLONTA® at ZynlontaHCP.com.
Once you send in the completed enrollment form, a benefits investigation is initiated.
Within 24-48 hours, your office will receive next steps related to the benefits investigation. Keep in mind a prior authorization and/or appeal may be needed. Be sure to fill in all
patient information and signatures on the ADVANCING Patient Support enrollment form to minimize delays.
Unfortunately, ADVANCING Patient Support cannot fill out or send prior authorization paperwork or draft letters (eg, letters of medical necessity) for you. ADVANCING Patient Support provides example letters you can refer to in preparing your responses to the patient's health plan.
Download the example Letter of Medical Necessity and example Letter of Appeal to get started.
Often with new products, prior to medical policy development, you may encounter terms such as “non-formulary product,” “NDC blocked,” or “medical exception.” Each of these can typically be approached through the medical exceptions process, which is often handled similarly to how a prior authorization is handled, and is specific to a given payer. Specific process information can typically be found online or through the payer’s provider relations department.
For more information or support, contact ADVANCING Patient Support at 1-855-690-0340.
After the benefits investigation is completed, ADVANCING Patient Support will assess your patient for the commercial copay and patient assistance programs, if requested. You will receive a fax to let you know the status of your patient’s eligibility.
Be sure to complete all aspects of the enrollment form (including signatures) to avoid delays.
ADVANCING Patient Support can help answer your coding and billing questions related to ZYNLONTA®. It's important to consider the following:
- Understand coding/billing requirements on a payer-specific basis
- Use the J-code for ZYNLONTA® for dates of service on or after April 1, 2022: J9359 (Injection, loncastuximab tesirine-lpyl, 0.075 mg)
- Respond quickly to any documentation requests
- Keep copies of all submitted claims
- Electronic submission can improve payment turnaround time and reduce errors
- Coverage denials can be common with new products
- Oftentimes, denials may result from minor errors, such as improper coding—plans may simply need additional information
- A rejection, on the other hand, needs to be corrected and resubmitted
- Be sure to check with the patient's health plan to understand their requirements and timelines
- Either way, ADVANCING Patient Support can help you throughout the process
Download the Coding/Billing Guide for general reference information.
Information provided by ADVANCING Patient Support is not a guarantee of coverage or reimbursement for any product or service.
Yes, ADVANCING Patient Support can help find out why your claim was denied by the health plan and help you identify what information may be needed as you prepare the appeal. Once your appeal is filed, we can follow up with the health plan on your behalf until a coverage decision is made.
There are two ways to submit a copay claim:
-
Electronically, with an ANSI X12 837 request for payment. The provider can use their own billing system to submit using the ADVANCING Patient Support information:
Payer ID: 56155
Group: 00003665
Member ID: (9 characters, unique to each patient)
-
Mail or Fax:
ADVANCING Patient Support Copay Program
2250 Perimeter Park Drive, Suite 300
Morrisville, NC 27560
Toll-free Fax: 1-855-915-3005
The ADVANCING Patient Support Copay Program is acting as a secondary payer. If the claim is submitted electronically, the Coordination of Benefits (COB) Payer Amounts will need to be entered for ZYNLONTA®.
If the claim is a manual submission (via fax or mail), please include a secondary claim form (CMS-1500, UB-04, etc) plus the primary Explanation of Payment (EOP) or Remittance Advice (RA).
Claim and supporting documents should include line-level detail so that the patient responsibility for ZYNLONTA® after primary is clear. Details should include the following:
- HCPCS and NDC
OR
- HCPCS and product name
Claims with missing documents or insufficient detail may be denied or misrouted.
Resources and Forms
Getting Started Brochure
Download the ZYNLONTA® “Getting Started” brochure for a brief overview of ADVANCING Patient Support, as well as guidance about how to dose, administer, and order ZYNLONTA®.
Download
Dosing and Administration Guide
For in-depth information about dosing and administration, download the ZYNLONTA® Dosing and Administration Guide.
Download
Patient Brochure
Download the ZYNLONTA® Patient Brochure to share with your patients as you discuss what to expect from treatment.
Download
Enrollment Form
You can download this form directly here, and then submit the completed form via email to support@ADVANCING PatientSupport.com or fax to
1-855-915-3005.
You can also enroll your patients online.
Download
Coding/Billing Guide
This guide provides you with helpful information to assist you when coding and billing for ZYNLONTA®. This information is intended as a guide for general reference and education only.
Download