Patient Access Program – Provider Registration

Increasing Your Patients’ Access to VivAer^® and RhinAer^®

The Aerin Reimbursement Center (ARC) is available to assist you and your patients with the reimbursement process to support patient access to VivAer and RhinAer. Our expert ARC Reimbursement Specialists can facilitate the prior authorization process in addition to supporting member-based appeals. Please contact us today and we will be glad to initiate the process for your patients.

Aerin Reimbursement Center (ARC)

Available Monday – Friday, 8:30am to 5:00pm EST

Phone: (844) 919-8560 Fax: (866) 440-8501

Email: ARCSupport@aerinmedical.com

Practice Name(Required)

Practice Contact Phone(Required)

Address(Required)

Practice Address Line 1 Practice Address Line 2 Practice City Practice State Practice Zip Code

Physician Name

Physician NPI

Practice Contact Name(Required)

Practice Contact Email(Required)

Once you complete and submit the registration form, we will contact you to provide instructions on how to submit authorization or appeal support requests. If you would prefer immediate assistance or if you have questions, please contact the Aerin Reimbursement Center by phone or email, and we will be glad to assist you.

Aerin Reimbursement Center (ARC)

Available Monday – Friday, 8:30am to 5:00pm EST

Phone: (844) 919-8560 Fax: (866) 440-8501

Email: ARCSupport@aerinmedical.com

AERIN REIMBURSEMENT CENTER (ARC)

Increasing Your Patients’ Access to VivAer® and RhinAer®

Increasing Your Patients’ Access to VivAer^® and RhinAer^®