Reimbursement Claim Support Letters
To assist with your practice's reimbursement process, the Merck Vaccine Reimbursement Support Center provides you with sample advocacy letters concerning various reimbursement issues. Letters are customized by Merck vaccine product. To download a letter, click on one of the links in the table, below.
| Product |
Denied Letter |
Reconsideration Letter |
Pre-certification Letter |
COMVAX®
[Haemophilus b Conjugate (Meningococcal Protein Conjugate) and Hepatitis B (Recombinant) Vaccine] |
 |
|
|
GARDASIL®
[Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant] |
|
|
|
M-M-R®II
(Measles, Mumps, and Rubella Virus Vaccine Live) |
|
|
|
PedvaxHIB®
[Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate)] |
|
|
|
PNEUMOVAX®23
(Pneumococcal Vaccine Polyvalent) |
|
|
|
ProQuad®
(Measles, Mumps, Rubella and Varicella Virus Vaccine Live) |
|
|
|
RECOMBIVAX HB®
(version 1)
[Hepatitis B Vaccine (Recombinant)] |
|
|
|
RECOMBIVAX HB®
(version 2)
[Hepatitis B Vaccine (Recombinant)] |
|
|
|
RECOMBIVAX HB®
(version 3)
[Hepatitis B Vaccine (Recombinant)] |
|
|
|
RotaTeq®
(Rotavirus Vaccine, Live, Oral, Pentavalent)
|
|
|
|
VAQTA®
(version 1)
(Hepatitis A Vaccine, Inactivated) |
|
|
|
VAQTA®
(version 2)
(Hepatitis A Vaccine, Inactivated) |
|
|
|
VARIVAX®
(VARICELLA VIRUS VACCINE LIVE) |
|
|
|
| ZOSTAVAX® (Zoster Vaccine Live) |
|
|
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