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KEYTRUDA KEYTRUDA QLEX
Medication Guide
KEYTRUDA KEYTRUDA QLEX
Contact Us

To be contacted by a Field
Reimbursement Manager
or
request an appointment with
a Nurse Educator:

Contact The Merck Access Program
Mon-Fri, 8 AM to 8 PM (ET)
at 855-257-3932

Learn More About Coding and Coverage

CODING & Billing

This website contains relevant National Drug Codes and billing codes that may be applicable to you and your office staff.

Coding & Billing Information

The Sample CMS-1500 Form is a helpful resource that outlines important details and steps to follow while completing the CMS-1500 Form to ensure that all information and signatures are captured.

Sample CMS-1500 Form
(For Office-Based Physicians)

The Sample UB-04 Form is a helpful resource that outlines important details and steps to follow while completing the UB-04 Form to ensure that all information and signatures are captured.

Sample UB-04 Form
(For Hospital Outpatient Facilities)

COVERAGE & BENEFITS INFORMATION FOR KEYTRUDA

The Merck Access Program can contact insurers to obtain coverage and benefits information for KEYTRUDA. Contact The Merck Access Program Mon-Fri, 8 AM to 8 PM (ET) at 855-257-3932.

PRIOR AUTHORIZATIONS

If a prior authorization (PA) is required, or for assistance in understanding if a PA is required, The Merck Access Program may be able to help.

The PA checklist and sample letter can help you understand the documents and information that may be helpful when seeking a PA. As always, you should check for payer-specific requirements.

PRIOR AUTHORIZATION CHECKLIST

Once The Merck Access Program enrollment form is submitted, you may be notified 24 to 48 business hours later if a PA is needed for your patient. If needed, please work with The Merck Access Program and use this checklist to ensure that all necessary materials and information are submitted to the payer.

Prior Authorization Checklist

SAMPLE PRIOR AUTHORIZATION LETTER

Once The Merck Access Program enrollment form is submitted, you may be notified 24 to 48 business hours later if a PA is needed for your patient. If needed, please work with The Merck Access Program and use this sample letter template to write a letter to the payer.

Sample Prior Authorization Letter

APPEALS

If you have submitted a claim and the claim has been denied, you can submit an appeal to your patient’s insurer. The Merck Access Program may be able to help your office understand the information needed for an appeal submission.

  • The appeal checklist can help you understand the documents and information that may be helpful when filing an appeal. As always, you should check for payer-specific requirements.
    Appeal Checklist
  • The Sample Appeal Letter provides guidance that may be helpful when filing an appeal for a denied claim.
    Sample Appeal Letter
ENROLL NOW

Learn More About Coding and Coverage

CODING & Billing

This website contains relevant National Drug Codes and billing codes that may be applicable to you and your office staff.

Coding & Billing Information

The Sample CMS-1500 Form is a helpful resource that outlines important details and steps to follow while completing the CMS-1500 Form to ensure that all information and signatures are captured.

Sample CMS-1500 Form
(For Office-Based Physicians)

The Sample UB-04 Form is a helpful resource that outlines important details and steps to follow while completing the UB-04 Form to ensure that all information and signatures are captured.

Sample UB-04 Form
(For Hospital Outpatient Facilities)

COVERAGE & BENEFITS INFORMATION FOR KEYTRUDA QLEX

The Merck Access Program can contact insurers to obtain coverage and benefits information for KEYTRUDA QLEX. Contact The Merck Access Program Mon-Fri, 8 AM to 8 PM (ET) at 855-257-3932.

PRIOR AUTHORIZATIONS

If a prior authorization (PA) is required, or for assistance in understanding if a PA is required, The Merck Access Program may be able to help.

The PA checklist and sample letter can help you understand the documents and information that may be helpful when seeking a PA. As always, you should check for payer-specific requirements.

PRIOR AUTHORIZATION CHECKLIST

Once The Merck Access Program enrollment form is submitted, you may be notified 24 to 48 business hours later if a PA is needed for your patient. If needed, please work with The Merck Access Program and use this checklist to ensure that all necessary materials and information are submitted to the payer.

Prior Authorization Checklist

SAMPLE PRIOR AUTHORIZATION LETTER

Once The Merck Access Program enrollment form is submitted, you may be notified 24 to 48 business hours later if a PA is needed for your patient. If needed, please work with The Merck Access Program and use this sample letter template to write a letter to the payer.

Sample Prior Authorization Letter

APPEALS

If you have submitted a claim and the claim has been denied, you can submit an appeal to your patient’s insurer. The Merck Access Program may be able to help your office understand the information needed for an appeal submission.

  • The appeal checklist can help you understand the documents and information that may be helpful when filing an appeal. As always, you should check for payer-specific requirements.
    Appeal Checklist
  • The Sample Appeal Letter provides guidance that may be helpful when filing an appeal for a denied claim.
    Sample Appeal Letter
ENROLL NOW

The information available here is compiled from sources believed to be accurate, but Merck makes no representation that it is accurate. This information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer as to payer-specific requirements.

The information available here is not intended to be definitive or exhaustive and is not intended to replace the guidance of a qualified professional advisor. Merck and its agents make no warranties or guarantees, expressed or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.

You are solely responsible for determining the appropriate codes and for any action you take in billing. Information about HCPCS codes is based on guidance issued by the Centers for Medicare & Medicaid Services applicable to Medicare Part B and may not apply to other public or private payers. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes. Diagnosis codes should be selected only by a healthcare professional.