CDPHP Member Claim Form
15-0615-0415 CDPHP® Member Claim Form Member: Use this form to request reimbursement of out-of-pocket expenditures for Covered Services. Reimbursement will be made to the Subscriber and sent to the address on file.
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835 Transaction Companion Guide - CDPHP Home | Health ...
www.cdphp.comThis document is to be used in addition to the HIPAA 835 Implementation Guide. It is designed for implementation of the HIPAA Transaction for Health Care Claim Payment/Advice, also known as the Electronic Remittance Advice (ERA). Overview This Companion Guide will replace any previous CDPHP Companion Guide for 835 Health Care Claim transactions.
CRC Screening: FIT vs Cologuard (FIT-DNA)
www.cdphp.comCRC Screening: FIT vs Cologuard (FIT-DNA) Effectiveness, convenience, and cost are the three factors that determine which tests to pursue with a patient who is resistant to screening colonoscopy (as well as flexible sigmoidoscopy or CT colonography). Effectiveness: Though it is often cited that Cologuard has a sensitivity of 92% compared with FIT’s sensitivity of 74%, it is …
CDPHP Utilization Review Prior Authorization Form
www.cdphp.com2: Briefly describe the patient-specific symptoms and duration , medical justification, and summary of clinical findings for the request: In addition, supporting clinical documentation (including pertinent consultation/office visits, lab results, radiology reports, etc.) must be submitted via fax or mail. Photos must be mailed.
CDPHP® Utilization Review Prior Authorization/Medical ...
www.cdphp.comFax or mail this form to: CDPHP Utilization Review Department, 500 Patroon Creek Blvd., Albany, NY 12206-1057 Fax: (518) 641-3207 • Phone: (518) 641-4100 Please note: If the requirement for prior authorization for a particular service or procedure has been removed by CDPHP, there is no need for you to submit this form for consideration.
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See back of form for complete claim filing instructions
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