Referrals, Prior Authorizations, and Care Management
• You can submit your request online by signing in to tools and resources and using the referral and prior authorization tool. • You can also fill out and fax a prior authorization form located on the provider MA website in the forms section. Please be sure to use the correct form and include pertinent medical records. 9
Tags:
Form, Medical, Referral, Request, Authorization, Authorization form
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document:
Documents from same domain
8.03.502 Physical Medicine and Rehabilitation Physical ...
www.premera.comPage | 2 of 19 ∞ Type of Therapy Medical Necessity Physical medicine and rehabilitation — physical therapy (PM&R – PT) Physical medicine and rehabilitation — physical therapy (PM&R – PT), including medical massage therapy services — may be considered medically necessary when ALL of the
Rehabilitation, Medicine, Physical, Therapy, Physical medicine and rehabilitation physical, Physical medicine and rehabilitation physical therapy
Heritage Prime Network Flyer - Premera Blue Cross
www.premera.comValley Clinic EASTERN WASHINGTON Spokane • Hospitals: MultiCare Deaconess Medical Center, MultiCare Valley Hospital and Medical Center, Shriners Hospitals for Children, Spokane VA Medical Center • Practices: Cancer Care Northwest, MultiCare Rockwood Clinic, Spokane Digestive Disease Center Walla Walla • Hospitals: Jonathan M.
10.01.520 Review for Coverage in the Absence of a Medical ...
www.premera.comBENEFIT COVERAGE GUIDELINE – 10.01.520 Review for Coverage in the Absence of a Medical Policy, Pharmacy Policy, or Utilization Management Guideline Effective Date: June 1, 2018
Policy, Guidelines, Management, Medical, Pharmacy, Utilization, Pharmacy policy, Or utilization management guideline
1.01.527 Power Operated Vehicles (Scooters) (excluding ...
www.premera.comVehicle Ramp/Lift: Van lifts (used to lift a wheelchair/scooter into a truck or van), wheelchair lifts, wheelchair/scooter racks, vehicle ramps and other vehicle modifications or additions are excluded from coverage because they do not meet the definition of medical equipment.
Vehicle, Power, Operated, Scooter, Excluding, Power operated vehicles
Request for Certification of Disabled Dependent
www.premera.comMembership & Billing, MS 737 PO Box 3048 Spokane, WA 99220 Request for Certification of Disabled Dependent An Independent Licensee of the Blue Cross Blue Shield Association
Request, Dependent, Certifications, Disabled, Request for certification of disabled dependent
Formulary Premera Medicare Advantage
www.premera.comiii immediately remove the drug from our formulary and provide notice to members who take the drug. Other changes. We may make other changes that affect members currently taking a drug.
Other Coverage Questionnaire Enrollment
www.premera.com017316 (11-2007) www.premera.com Page 1 of 2 An Independent Licensee of the Blue Cross Blue Shield Association Other Coverage Questionnaire Enrollment
1.01.519 Patient Lifts, Seat Lifts and Standing Devices
www.premera.comPatient Lifts, Seat Lifts and Standing Devices Effective Date: Feb. 1, 2018 Last Revised: Jan. 16, 2018 ... A patient lift is used to safely move a patient who is unable to move themselves from a bed to a ... a sling lift or a sit-to-stand lift. This guideline explains when these items are covered.
Devices, Patients, Tlif, East, Standing, Stand, Patient lifts, Stand lift, Seat lifts and standing devices
Incident Questionnaire (Member Version) - Home | Visitor
www.premera.comP.O. Box 327 | MS 227 | Seattle, WA 98111 An Independent Licensee of the Blue Cross Blue Shield Association 005077 (09-2015) 1 of 2 To avoid possible delay in processing your claims, please complete, sign, and return this questionnaire within 45 days of receipt.
Questionnaire, Members, Home, Version, Incident, Incident questionnaire, Member version
Modifier 90 - Reference (Outside) Laboratory - Visitor
www.premera.com2 Center for Medicare and Medicaid Services (CMS) CMS Healthcare Common Procedure Coding System (HCPCS) code set Clinical Laboratory Improvement Amendments (CLIA) …
Laboratory, Reference, Medicare, Modifiers, Estudio, Modifier 90 reference
Related documents
Provider Preauthorization and Precertification Requirements
www.bcbsm.com• E-referral Electronic system for Michigan providers to submit requests for inpatient admission. ... Note: If you fail to submit your authorization request, submit an untimely request or your request is ... • Commercial PPO LTAC/SNF Enhancement Form Providers can call 1-800-249-5103 to obtain a status on Precertification requests by ...
Form, Commercial, Referral, Request, Authorization, Authorization request
Texas Standard Prior Authorization Request Form for …
www.bcbstx.comBeginning September 1, 2015, health benefit plan issuers must accept the Texas Standard Prior Authorization Request Form for Health Care Services if the plan requires prior authorization of a health care service. In addition to commercial issuers, the following public issuers must accept the form: Medicaid, the Medicaid managed
Health, Form, Standards, Commercial, Request, Authorization, Texas, Prior, Texas standard prior authorization request form for health, Texas standard prior authorization request form for
New Referral CCS/GHPP Client Service Authorization …
www.dhcs.ca.govNEW REFERRAL CCS/GHPP CLIENT SERVICE AUTHORIZATION REQUEST (SAR) Provider Information. 1. Date of request 2. Provider name 3. Provider number 4. Address (number, street) City State ZIP code . 5. Contact person 6. Contact telephone number ( ) 7. Contact fax number ( ) Client Information. 8. Client name—last first middle . 9. Alias (AKA) 10. Gender
INTRODUCING: UNIVERSAL PROVIDER REQUEST FOR CLAIM …
www.hcasma.orgHealthCare Administrative Solutions (HCAS) provides access to the Request for Claim Review Form and Reference Guide on its website for the convenience of health plans and their participating providers.