[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-280648-105":53,"doc-detail-280648-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","letter-of-appeal-guide-composing-a-letter-of-appeal","Letter of Appeal Guide - Composing a Letter of Appeal","","Guide for composing an appeal letter when a patient’s health plan denies coverage for Olumiant (baricitinib). Explains that appeals generally come from the patient and the prescribing HCP and should include the patient’s medical records and a Letter of Medical Necessity (LMN). Provides clinical tips for appeal submissions, including documenting diagnosis, ICD-10 codes, disease severity, prior therapies, and patient-specific treatment response, while focusing rationale strictly on the stated denial reason. Includes important safety information for Olumiant.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/letter-of-appeal-guide-composing-a-letter-of-appeal/280648/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/letter-of-appeal-guide-composing-a-letter-of-appeal/280648.png","ImageObject",442,249,{"name":88,"@type":89},"Lucas Martin","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-27","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",20,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"Who can originate the Olumiant coverage authorization appeal letter, and what must it include?","Question",{"text":109,"@type":110},"The appeal letter originates from the patient and the prescribing HCP. It should be submitted with the patient’s medical records and a Letter of Medical Necessity (LMN).","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What clinical information should be included to support overturning an Olumiant coverage denial?",{"text":114,"@type":110},"Include records with diagnosis details, ICD-10 code, and severity assessment (including SALT score or other tools), plus infection history, allergies, comorbidities, and how the patient is presenting on current treatment. Document prior therapies, dates, and discontinuation reasons when applicable.",{"name":116,"@type":107,"acceptedAnswer":117},"How should the appeal rationale be written relative to the denial reason?",{"text":118,"@type":110},"Clinical rationale should focus only on the stated denial reason. If the denial is due to not using the plan’s preferred formulary agents, provide clinical rationale for why those agents are not appropriate and why Olumiant is appropriate for the specific patient.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},280648,1789553546,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":47,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":126,"read_time":73},8796095360427,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Letter of Appeal Guide  \nThe following information is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current as of the issue date of this document, the information may not be as current or comprehensive when you view it. Providers are encouraged to contact the patient’s health plan for specific information on their coverage policies. For more information, please call Lilly Support Services™ for Olumiant® at 1-800-LillyRx (1-800-545-5979).  \nComposing a Letter of Appeal Guide  \nIf coverage is denied by the patient’s health plan, the plan may require an Appeal Letter. The sample letter attached to this document features information that many plans require to process a coverage authorization appeal. Many health plans require that a Letter of Medical Necessity (LMN) accompany submissions of Appeal, therefore consider including an LMN upfront with appeal submission. Please see the  LMN Guide for more details. Follow the patient’s plan requirements when requesting Olumiant® (baricitinib); otherwise, treatment initiation may be delayed. An Appeal Letter originates from the patient and the prescribing HCP. It should be submitted with the following 2 additional items: the patient’s medical records and a Letter of Medical Necessity (LMN).  \nAppeal considerations to support coverage  \nGeneral Clinical Information  \nBelow are 3 tips that may be helpful when appealing a coverage denial:  \n1. Provide a copy of the patient’s record with details on the patient’s condition (diagnosis/diagnoses), International Classification of Diseases, Tenth Revision (ICD-10) code, and assessment of severity of disease for which Olumiant is being/will be used, including:  \n‒ Severity of Alopecia Tool (SALT) score  \n‒ alternative disease severity classification tool(s)  \n‒ recent history of infection(s), along with any allergies and existing comorbidities  \n2. Provide information about the current treatment(s) being used for the patient’s condition and how the patient is presenting clinically while taking the current treatment(s)  \n3. Document the previous therapies used, dates used, and reasons for discontinuation (if applicable)  \nAppeal-specific rationale  \nThe following tips may help construct an appropriate appeal:  \n• Provide clinically relevant and patient-specific information that supports overturning denial  \n• If denial was duetothe plan’s preferred formulary agents not being used to treat this patient, provide the clinical rationale for why these agents are not appropriate for the patient  \n• Provide clinically relevant and patient-specific information that makes Olumiant an appropriate therapy for this patient  \nLilly Support Services™ will work with you to help navigate patient access  \nFor more information, please visit [https://olumiant.lilly.com/hcp/support-resources](https://olumiant.lilly.com/hcp/support-resources or call Lilly Support Services)[ or call Lilly Support Services](https://olumiant.lilly.com/hcp/support-resources or call Lilly Support Services)™ at 1-800-LillyRx (1-800-545-5979) .  \nINDICATION  \nClinical rationale should focus only on the stated denial reason.  \nConsider including disease severity classification tool in chart notes or attachments to support Appeal Letter (i.e., Alopecia Areata Scale)  \nOlumiant is a Janus kinase (JAK) inhibitor indicated for the treatment of adult patients with severe alopecia areata.  \nLimitations of Use: Not recommended for use in combination with other JAK inhibitors, biologic immunomodulators, cyclosporine or other  \npotent immunosuppressants.  \nSELECT IMPORTANT SAFETY INFORMATION: WARNING RELATED TO SERIOUS INFECTIONS, MORTALITY, MALIGNANCY, MAJOR ADVERSE CARDIOVASCULAR EVENTS, AND THROMBOSIS  \nSERIOUS INFECTIONS: Olumiant-treated patients are at increased risk of serious bacterial, fungal, viral and oppor","cbCait7cZMtuZQSI","https://ap.wps.com/l/cbCait7cZMtuZQSI","pdf",274192,"English","# Composing a Letter of Appeal Guide\n## Appeal considerations to support coverage\n### General Clinical Information\n### Appeal-specific rationale\n## Lilly Support Services™ and indication/safety overview","[{\"question\":\"Who can originate the Olumiant coverage authorization appeal letter, and what must it include?\",\"answer\":\"The appeal letter originates from the patient and the prescribing HCP. It should be submitted with the patient’s medical records and a Letter of Medical Necessity (LMN).\"},{\"question\":\"What clinical information should be included to support overturning an Olumiant coverage denial?\",\"answer\":\"Include records with diagnosis details, ICD-10 code, and severity assessment (including SALT score or other tools), plus infection history, allergies, comorbidities, and how the patient is presenting on current treatment. Document prior therapies, dates, and discontinuation reasons when applicable.\"},{\"question\":\"How should the appeal rationale be written relative to the denial reason?\",\"answer\":\"Clinical rationale should focus only on the stated denial reason. If the denial is due to not using the plan’s preferred formulary agents, provide clinical rationale for why those agents are not appropriate and why Olumiant is appropriate for the specific patient.\"}]","Letter of Appeal Guide - Composing a Letter of Appeal | PDF"]