• MySynviscONE^™
• Benefit Verification

Medical & Pharmacy Benefit Verification

Exclusively for the SYNVISC^® family

On average, 98% of patient cases that were
NOT cancelled received coverage.^†

Careform stands behind the accuracy of results provided through the program, MySynviscONE^™BV. If a claim is denied as a result of an error by MySynviscONE^™BV, the practice will be eligible for reimbursement up to their SYNVISC and/or Synvisc-One^® product cost.

MySynviscONE^™BV is a portal to help you:

• Verify insurance benefits (medical and pharmacy)
• Obtain prior authorizations
• Coordinate specialty pharmacy fulfillment
• Track the progress of each case at any time
• Electronically submit prior authorization forms
• Electronically submit specialty pharmacy submissions

^†Data on file.

^‡If submitted by 1 PM Eastern Time and no prior authorization or additional information required.

Program features:

eSignature

Integrated into the benefit verification and prior authorization submission forms—no need to print, sign, and upload prescriptions

Electronic prior authorization forms

Available for select payers

E-mail alerts

Users may opt in to benefit verification e-mail notifications:

• Daily status report of all open cases
• Alerts triggered by status changes, completion, or information requests

Re-injection report

Benefit verification summary report

A summary report is generated for each patient as soon as his or her benefits are verified

Print the MySynviscONE™ Benefit
Verification Fact Sheet

Activate your MySynviscONE^TM account

Call 1-844-MYSYNVISC Monday through Friday, 8 a.m. to 7 p.m., excluding
major holidays, or fill out this form, and our team will contact you.

Request MySynviscONE^TM Information ›