Discover Resources & Support
View or download resources for you, your practice, ASC, or patients
Reimbursement Assistance
Reimbursement Guide
Review this important office guide for coding and billing assistance, including sample claim forms
Download
We Pay the Difference Fact Sheet
Review this guide for an overview on how to complete the enrollment process for each commercially insured We Pay the Difference patient
Download
We Pay the Difference Submission Form
Enroll commercially insured patients in the We Pay the Difference reimbursement program
Download
OMIDRIAssure Patient Certification Form
Determine patient eligibility for the Equal Access patient assistance program
Download
Letter of Medical Necessity
Use this template letter to communicate with payers; this letter can be customized to establish the medical reason that OMIDRIA was used
Download
Letter of Appeal
Use this template letter to communicate with payers; this letter can be customized to appeal a payer’s decision not to reimburse the use of OMIDRIA
DownloadFor more information, please contact an OMIDRIA Field Reimbursement Manager.
For more information, please contact a Rayner Sales Representative.
For more information, please contact a Rayner Sales Representative.
ASC=ambulatory surgery center; HOPD=hospital outpatient department.