Highmark Blue Shield Medical Management and …

Revised 3.1.2015 Name of Requestor/Contact Person: _____ Patient’s Name: Patient Phone # Patient’s Address: Date of Birth: Member UMI: Suffix # …

Highmark Blue Shield Medical Management and Policy ...

3.1.2016 CLINICAL DOCUMENTATION AND Name of Requestor/Contact Person Requestor’s Phone Number Member ID Number Patient Name Patient Phone Number

  Policy, Medical, Blue, Shield, Highmark, Highmark blue shield medical

Advanced Imaging and Cardiology Services Program Codes ...

75565 Cardiac magnetic resonance imaging for velocity flow mapping (list separately in addition to code for primary procedure) 75571 . Computed tomography, heart, without contrast material, with …

  Imaging, Tomography, Computed, Computed tomography

Some authorization requirements vary by member plan. s ...

standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels e0639 patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories e0642 standing frame/table system, mobile (dynamic stander), any size including pediatric

  Stander

NaviNet User Guide - content.highmarkprc.com

Benefits Submission If the member’s primary insurer is not Highmark, you will need to adjust the Coordination of Benefits for the claim. 1. Choose Claim Submission from the left navigation on Plan Central and then complete Patient Entry Screen. 2. Payer Screen: Fill in the primary payer Explanation of Benefits (EOB) information by changing ...

  Benefits, Claim, Explanation, Explanation of benefits, Of benefits

SPECIALTY DRUG REQUEST FORM

SPECIALTY DRUG REQUEST FORM To view our formularies on-line, please visit our Web site at the addresses listed above. Fax each form separately. Please use a separate form for each drug.Print, type or write legibly in blue or black ink. See reverse side for additional details. Once completed, please fax this form to1-866-240-8123.

  Form

2021 Adult Preventive Health Guidelines: Ages 19 through ...

The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion (ie, cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer.D Recommendation

  Guidelines, Screening, Cancer, Cervical, Cervical cancer

Highmark Reimbursement Policy Bulletin

Jul 15, 2019 · Page 3 of 12 When a covered benefit, evaluation and management and consultation services delivered through telehealth for *new and established patients may be reimbursed under the following conditions: *Note: In accordance with the telehealth waiver issued by CMS related to the 2019 novel coronavirus, new patients will be permitted to receive telehealth services …

F02 General Consent For Medical/Surgical Procedures ...

General Consent For Medical/Surgical Procedures/Interventions _____ _____ Patient Name Medical Record Number TO THE MEMBER: You have been given information about your condition and the recommended surgical, medical, or diagnostic procedure(s). This consent form is designed to provide a written ...

  Interventions, Surgical

Physician Patient Termination Letter

THIS IS ONLY A SAMPLE!!! PLEASE WRITE YOUR OWN BASED ON THE SPECIFIC NEEDS/SITUATION OF YOUR PRACTICE. PHYSICIAN/PATIENT TERMINATION PROTOCOLS The patient must be given clear and reasonable notice of the physician’s intent to withdraw as the primary care physician from the case. If at all possible, the

  Patients, Your, Practices, Samples, This, Only, Your practice, This is only a sample

508C Provider Administration Manual

Provider Administration Manual . 3 . 23. Phenylketonuria (PKU) Treatment 24. Prosthetic Appliances 25. Orthotic Devices 26. Therapy and Rehabilitation Services 27. Hospice Services 28. Vision Services 29. Dental Services 30. TennCare for Prisoners Program B. Benefit Exclusions. V. Billing and Reimbursement. A. How to File a BlueCare Tennessee ...

  Administration, Manual, Provider, Billing, Entrance, Provider administration manual

2020 Care Provider Manual - Tennessee

The Division of TennCare requires specific language in TennCare Provider Agreements. As noted in the Modification Section of your Provider Agreement, Division of TennCare required language and State of Tennessee mandates about the TennCare program can be updated by inclusion in the care provider manual.

  Manual, Tennessee, Provider, Provider manual, Entrance, Tenncare provider