Reimbursement Information

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3-Step XIFAXAN Reimbursement

Step 1: Fill Out The Form

Download the Patient Information Form and fill it out.

 Patient Information Form (PDF 19KB)

 Patient Information Form (MS-Word)

For easy-to-follow instructions and an example of a filled-out Patient Information Form, click below to view our brochure, "Completing the Patient Information Form."

 Completing the Patient Information Form (PDF 254KB)

Step 2: Get Questions Answered

This free support service connects trained reimbursement analysts with XIFAXAN® customers to answer questions regarding the Patient Information Form and to provide reimbursement support. Our staff can also negotiate appeals on behalf of your patients, should their claims be denied

XIFAXAN Reimbursement Helpline
1-866-XIFAXAN
1-866-943-2926

Open Monday through Friday, 8:30 AM to 5:30 PM Eastern Standard Time

What should you have before calling?
To make the most efficient use of your time, complete the Patient Information Form (PDF 19KB) before calling and have it with you.

Step 3: Submit Completed Form

Completed claim forms must be submitted via this fax number.

XIFAXAN Reimbursement Fax Line
1-800-387-5807

Reasons to contact the XIFAXAN Reimbursement Helpline

The XIFAXAN Reimbursement Helpline can provide a timely solution to issues you may encounter either before or after submitting a patient claim for reimbursement.

• Receive current reimbursement policies for private payers, Medicaid, and Medicare
• Verify individual patient coverage
• Verify insurance coverage associated with the patient assistance program
• Conduct prior authorizations
• Manage negotiation of appeals on denied claims
• Receive customized information to assist with coverage or appeals

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