Appeals and Collections Sample Clauses

Appeals and Collections. Nova Factor shall use its commercially reasonable best efforts to obtain reimbursement from the patient and/or the third party payer or other payer, including in the event of a denial of insurance coverage, prosecuting all Appeals. Said Appeals shall include at least the following steps unless such step is not available: (a) obtaining a written denial of payment which sets forth the rationale for such denial; (b) sending a written appeal to the third party payer setting forth comprehensively the nature of the appeal and providing all relevant support for the appeal; and (c) sending a written appeal to the next higher level of appeal at that third party payer. As a general matter, Nova Factor will ship on first level Appeals, and on second level Appeals when the clinical information of the patient falls within reasonable medical review criteria for treating growth hormone inadequacy. Nova Factor is not required to ship on patients with pre-existing clauses, lack of coverage for injectables, or no Rx coverage.