How to Get Paid from Co-Pay Cards: A Guide for Administering Spravato

Many healthcare practices wish to supply and administer Spravato but often get lost in the claims process, leading them to believe they are losing money. This guide focuses on Spravato, but the process is similar for any buy-and-bill medication. If buy-and-bill is in your plans, there is a straightforward process to follow.

Step-by-Step Guide

1. Obtain Prior Authorization

   • Begin by getting prior authorization through the patient's medical benefit. Remember, only pharmacies can bill if it is approved through the pharmacy benefit.
   • For Spravato, your approval should indicate approval for code S0013.

2. Enroll the Patient in the Savings Program

   • Once you have the patient's prior authorization, enroll the patient in the savings program. For Spravato, this is done through the Spravato with Me provider portal.

3. Record Secondary Insurance Information

   • List the patient's secondary insurance as "Carepath Card."
   • Record the ID number as the medical ID number found on the patient's savings card.

4. Billing Process

   • After the patient's visit, bill the primary insurance first.
   • Once the primary insurance pays the claim, bill the Carepath Card for the "patient responsibility" amount specifically for the Spravato code (S0013).
   • Note that Carepath will not cover the patient's portions of the observation codes.
   • Carepath will pay the patient responsibility amount minus $10, which is the required copay.

Important Notes

• The primary insurance must be billed and the claim processed before billing the Carepath Card.
• Ensure all documentation is accurate and corresponds to the appropriate codes to avoid claim denials or delays.

Following these steps will help streamline the process of getting paid through co-pay cards, ensuring your practice can efficiently administer Spravato and other buy-and-bill medications without financial losses.

This guide is intended for informational purposes only and should not be construed as legal advice. Processes and requirements may vary by insurer and jurisdiction. It is recommended that you consult with a professional biller or legal advisor to ensure compliance with all applicable regulations and guidelines.