New Enhanced OMIDRIAssure® Patient Access Programs

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Discover Resources & Support

View or download resources for you, your practice, ASC, or patients

Reimbursement Assistance

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Reimbursement Guide

Review this important office guide for coding and billing assistance, including sample claim forms

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Thumbnail of OMIDRIAssure® Flashcard

OMIDRIAssure® Flashcard

Learn about the OMIDRIAssure program, which offers patients assistance with the cost of OMIDRIA

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Thumbnail of We Pay The Difference Submission Form

We Pay the Difference Submission Form

Enroll commercially insured patients in the We Pay the Difference reimbursement program

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Thumbnail of OMIDRIAssure® Patient Certification Form

OMIDRIAssure Patient Certification Form

Determine patient eligibility for the Equal Access patient assistance program

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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

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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

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Thumbnail of OMIDRIAssure® Update Announcement

OMIDRIAssure Update Announcement

Overview of new OMIDRIAssure enhancements, including our advanced technology platform and user-friendly dashboard

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For more information, please contact an OMIDRIA Field Reimbursement Manager.

Ordering and Using OMIDRIA

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Ordering Information Sheet

See wholesaler/distributor and billing information for OMIDRIA

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Procedure Guide

Learn how to store, prepare, and administer OMIDRIA

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For more information, please contact a Rayner Sales Representative

Patient Education

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Thumbnail of OMIDRIA Patient Brochure

Patient Brochure

Provide your patients with information to help answer their questions about OMIDRIA

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Payment Schedules

HOPD Payment Schedule

Select the latest Addendum B payment schedule for current HOPD payment information

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ASC Payment Schedule

Select the latest quarterly ASC payment rate Addendum BB file for current ASC payment information

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ASC=ambulatory surgery center; HOPD=hospital outpatient department.

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