Diagnosis verification

Diagnosis and treatment verification by a member of the patient’s care team is required for all approved TotalAssist applicants within 30 days of approval. If verification is not received within 30 days, the patient’s grant will be closed.

Patients and caregivers / Nonprofit patient partners

TotalAssist contacts the patient’s healthcare provider directly to obtain diagnosis and treatment plan verification. We fax a barcoded, patient-specific Diagnosis Verification Form to your provider to complete and fax back to us. Approved patients can submit claims for covered expenses during this period.

If you received a reminder letter about diagnosis verification

After 15 days, if your provider has not yet verified diagnosis and treatment status, we will notify you with a letter. Depending on the preference you indicated, you will receive a letter by mail or by email. The letter will also be posted to your portal account. We request that you follow up with your provider to ensure the Diagnosis Verification Form is submitted before the 30-day deadline.

If your provider did not receive our fax, please verify their fax number and call us at 866-512-3861 to request that another copy be sent. We will re-send your barcoded, patient-specific Diagnosis Verification Form to the provider. They can fax the completed form back to TotalAssist at 757-952-0119 (no cover sheet needed).

Your barcoded, patient-specific Diagnosis Verification Form can also be downloaded from your portal account. If you need help with this, chat live or call us at 866-512-3861, Monday-Friday 8:30 am to 5:30 pm ET.

Pharmacies

When applying for a TotalAssist grant on behalf of a patient, supporting documentation is required from the pharmacy to substantiate the patient’s diagnosis and treatment information. An authorized pharmacy representative can submit this documentation from the pharmacy system that confirms the information provided by the prescriber. If you do not upload supporting documentation, we will contact the provider directly for diagnosis verification.

Acceptable supporting documentation

Supporting documentation must include the following required information:

• Patient name
• Patient date of birth
• Diagnosis name
• Diagnosis ICD-10 code
• Treating physician name
• Facility name
• Provider NPI
• Medication being prescribed and dispensed

Preferred forms of documentation

• If submitted with online application:
  • Screenshots of patient record from pharmacy system
  • Screenshots of required information from electronic prescription request
• If submitted by fax:
  • Copy of electronic prescription that includes ICD-10 code
  • Copy of insurance prior authorization that includes diagnosis by name or ICD-10
  • Copy of benefits investigation that includes diagnosis by name or ICD-10
  • Copy of chart notes or communications from provider that includes diagnosis by name or ICD-10

How to submit supporting documentation

• Submit required documentation during the application process, or
• Fax to us at 757-952-0199 using the barcoded, patient-specific fax cover sheet. The fax cover sheet can be found in the patient’s portal record.

Providers

When applying for a TotalAssist grant on behalf of a patient, providers sign an attestation of the accuracy of the diagnosis and treatment plan with the application.

If the application is initiated by the patient or caregiver, or a nonprofit patient support partner on behalf of the patient, TotalAssist will fax the required Diagnosis Verification Form to the treating provider directly on behalf of the patient. This form is a barcoded, patient-specific form linked to the patient’s application. We must receive verification of diagnosis and treatment status from the provider no later than 30 days after approval. Approved patients who do not have their reported diagnosis and treatment plan verified by their medical care team within 30 days from approval will forfeit their award.

If you did not receive our fax, please call us to request that another copy be sent. We will re-fax you the barcoded, patient-specific Diagnosis Verification Form. To submit the completed form to TotalAssist, fax to 757-952-0119 (no cover sheet needed).

Contact us if you have questions or need help with verification

Chat live on our website, or call us at 866-512-3861, Monday – Friday, 8:30 – 5:30pm ET.