Transcription of Instructions for Submitting REQUESTS FOR …
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Instructions for Submitting REQUESTS FOR …
Instructions for Submitting REQUESTS FOR PREDETERMINATIONS Predeterminations typically are not required. A predetermination is a voluntary, written request by a provider to determine if a proposed treatment or service is covered under a patient s health benefit plan. Predetermination approvals and denials are usually based on our medical policies. View medical policies. The provider and member will be notified when the final outcome has been care REQUESTS include any request for a predetermination with respect to which the application of the time periods for making nonurgent care determinations; a. could seriously jeopardize the life or health of the member or the ability of the member to regain maximum function, orb.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 729617.0318
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