Payers may reject a prior authorization request or procedure claims for a variety of reasons.

Submitting supporting documentation is a strong factor in the review process. Claims submitted with proper coding and documentation will reduce the likelihood of denials because of technical errors or product unfamiliarity.

Appeals Letter	Description: Letters of appeal provide written justification for denied claims. Download: Example appeals letter (38kb pdf)

Reasons for denial may include:

• Clerical errors such as misspellings and transposed numbers
• Questions about medical necessity
• Unfamiliarity with the class of drug
• Improper use of codes
• Insufficient documentation/missing information           

For a step-by-step guide to the appeals process, please download the complete Reimbursement Guide or contact the Elan Pain Information Center (EPIC) at 1-888-PRIALT-1 (1-888-774-2581) for assistance in appealing a claim.