Claims Appeals Checklist

When appealing a denied claim, payers may request additional documentation (if not submitted with the original claim) including:

  • Sample letter of appeal
  • Copy of the original claim
  • Copy of the denial notification from payer
  • LUTATHERA® (lutetium Lu 177 dotatate) Prescribing Information
  • FDA-approval letter
  • Copy of invoice
  • Patient’s medical history, including clinical notes
  • Copy of referring physician’s order
Please be informed that we have adopted new enrollment forms, starting from August 1, 2018. If you need assistance with completing the forms, please call AAA PatientCONNECT at 1-844-NETS-AAA.
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