MONJUVI Patient Brochure (1.7 MB)

Review what you may expect during treatment with MONJUVI

MONJUVI Billing & Coding Guide (4 MB)

Utilizing appropriate codes on claim forms is required in order to obtain timely and appropriate reimbursement. Use this sample guide to provide information about relevant codes for MONJUVI, including:

• Product Codes
• Procedure Codes
• National Drug Codes (NDCs)
• Revenue Codes for the physician office setting as well as the hospital outpatient setting

Medical Exceptions & Patient Support Services Guide (3 MB)

The My MISSION Support Medical Exceptions & Patient Support Services Guide provides tools and Information that can help address potential medical exceptions

Sample Claim Forms:

Sample Claim Form for the Physician Office Setting (CMS-1500) (845 KB)

Medicare Sample Claim Form for the Hospital Outpatient Setting (CMS-1450) (679 KB)

Non-Medicare Sample Claim Form for the Hospital Outpatient Setting (CMS-1450) (673 KB)

Sample Appeals Letters:

Sample Letter of Medical Necessity (61 KB)

A patient's insurance company may request a letter of medical necessity for prescribing MONJUVI. Use this sample as a guide to develop your own response to this type of request

Sample Letter of Medical Exceptions (63 KB)

An exception request is a specific type of coverage determination asking a payer to reconsider an adverse tiering or formulary decision. Use this sample as a guide to create your own letter requesting an exception for MONJUVI

Sample Appeal Letter (63 KB)

If your claim is denied, use this sample correspondence, which outlines the appeal requirements to create your own letter

MONJUVI Product Ordering Guide (623 KB)

This Product Information and Ordering Guide includes information about MONJUVI and its select network of Specialty Distributors or Specialty Pharmacies

My MISSION Support Program Brochure (150 KB)

A comprehensive guide describing the services offered by My MISSION Support and how to access them

My MISSION Support Enrollment Form (100 KB)

Download and complete the My MISSION Enrollment Form to initiate program offerings. You can also enroll online by clicking on the link below