enterade® may be eligible for reimbursement from health insurance plans if they cover medical foods and when prescribed for a medical need*
Coverage depends on the insurance provider and plan.
As the manufacturer, Enterade cannot bill insurance directly.
*Must be used to treat a medical condition and be prescribed by a licensed healthcare professional to treat an illness or condition
To check if Enterade is covered by your insurance plan, follow the steps below:
-1-
Call your insurance carrier
Patient calls member services line or provider calls provider line and lets them know enterade is ordered and calling to check if it is covered.
-2-
Provide the NDC code
to the insurance carrier
Enterade® IBS-D Mixed Berry
NDC Code 60008-0321-11
-3-
Insurance Carrier will let the Patient Know if Enterade is Covered
-4-
IF COVERED:
Ask what they need: prescription, clinical notes, and/or letter of medical necessity
-5-
If No Pharmacy Nearby…
Ask if you can purchase product directly from manufacturer and submit for reimbursement with a claim form
If Enterade is covered, obtain a prescription from a physician or a health care provider
-1-
The Rx Needs to Include Patient’s Name, Date of Birth, & Diagnosis
-2-
Sample Rx
enterade 2x/day x 30 days plus 2 refills
-3-
Needs to Include Diagnosis/Reimbursement Codes (ICD 10)
Code Examples:
a. Irritable bowel syndrome: K58.9
b. Diarrhea: R19.7
c. Electrolyte imbalance: E87.8
e. Dehydration: E86.0
h. Leaky gut syndrome: K59.9
If Prior Authorization is Required, Follow These Steps:
-1-
Submit clinical notes
Anything nutrition related to Oncology or GI
-2-
Complete Letter of Medical Necessity
For Flexible Spending/Health Spending Accounts
Enterade is covered by FSA/HSA if used to treat a medical condition and prescribed by a licensed healthcare professional
-1-
Obtain a Rx for Enterade as outlined above
sample Rx:
enterade 2x/day x 30 days plus 2 refills
-3-
Submit to your FSA Carrier for Reimbursement
Submit prescription & a copy of your receipt
For Pharmacy or DME Use Only
Must be a pharmacy/DME that carries Enterade
-1-
Patient must have a prescription for Enterade
-2-
Bill with HCPCS or NDC Code
Enterade® IBS-D Mixed Berry
HCPCS Code B4102 (Adults) , B4103 (Pediatrics)
NDC Code 60008-0321-11