Discover Resources & Support
View or download resources for you, your practice, ASC, or patients
Reimbursement Assistance
![Thumbnail of Reimbursement Guide](/static/media/images/Reimbursement-Guide-2022.original.png)
Reimbursement Guide
Review this important office guide for coding and billing assistance, including sample claim forms
Download![Thumbnail of We Pay the Difference Fact Sheet](/static/media/images/We-Pay-the-Difference-Face-Sheet-2022.original.png)
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![Thumbnail of We Pay The Difference Submission Form](/static/media/images/We-Pay-the-Difference-Submission-Form-2022.original.png)
We Pay the Difference Submission Form
Enroll commercially insured patients in the We Pay the Difference reimbursement program
Download![Thumbnail of OMIDRIAssure® Patient Certification Form](/static/media/images/OMIDRIAssure-Patient-Certification-Form-2022.original.png)
OMIDRIAssure Patient Certification Form
Determine patient eligibility for the Equal Access patient assistance program
Download![Thumbnail of Letter of Medical Necessity](/static/media/images/Letter-of-Medical-Necessity-2022.original.png)
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![Thumbnail of Letter of Appeal](/static/media/images/Letter-of-Appeal-2022.original.png)
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.