PRIOR AUTHORIZATION LIST - Paramount Health Care
PG0007 Blepharoplasty, Reconstructive Eyelid Surgery, and Brow Lift BRONCHIAL THERMOPLASTY NON-COVERED NON-COVERED NON-COVERED X 31660, 31661 PG0316 Bronchial Thermoplasty
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Prior Authorization List 6 19 18 - Paramount Health …
www.paramounthealthcare.comHPV VACCINES - PRIOR AUTHORIZATION FOR ONLY 27YO OR OLDER X X NON-COVERED X 90649, 90650, 90651 - If the HMO, PPO, Individual Marketplace, or
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Paramount Advantage™ Preferred Drug List
www.paramounthealthcare.com4 INTRODUCTION We are pleased to provide the 2018 Paramount Advantage™ Preferred Drug List as a useful reference and informational tool. This is a list of medications which are preferred by Paramount Advantageand commonly
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www.paramounthealthcare.comParamount Insurance Company Small/Large Group Ohio Commercial FLEX Network Benefits Member Handbook www.paramountinsurancecompany.com Paramount is the health insurance option that offers a diverse line of products,
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BRAND NAME GENERIC BRAND NAME CLASS
www.paramounthealthcare.com2012 ACE /ARB Reference List BRAND NAME GENERIC BRAND NAME CLASS Accupril Quinapril ACE inhibitor Accuretic Hydrochlorothiazide-Quinapril ACE inhibitor
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POLICY: PG0004 MEDICAL POLICY: ORIGINAL EFFECTIVE: …
www.paramounthealthcare.comExtracorporeal Shock Wave Therapy (ESWT) is a non-surgical treatment that involves the delivery of shock waves to musculoskeletal areas of the body (commonly the epicondyle, shoulder, or heel), with the goal of reducing pain
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MEDICAL POLICY Chronic Care Management (CCM) Services
www.paramounthealthcare.comcare professional with no face-to-face visit, per calendar month (Complex chronic care management services of less than 60 minutes duration, in a calendar month, are not reported separately.) 99489 Complex chronic care coordination services; each additional 30 …
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Medical Coverage Waiver Form - 2016
www.paramounthealthcare.comMedical Coverage Waiver Form | January 2016 www.paramounthealthcare.com Medical Coverage Waiver Form Section 1: Employee Information
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Approved Formulary File Submission ID 00019350, Version ...
www.paramounthealthcare.comApproved Formulary File Submission ID 00019350, Version Number 9 H3653_2019StandardComp_C This formulary was updated on 03/01/2019.For more recent information or other questions, please contact Paramount Elite (HMO) /
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www.paramounthealthcare.comPOLICY: PG0203 MEDICAL POLICY: ORIGINAL EFFECTIVE: 01/15/09 LAST REVIEW: 03/19/19 Skin Substitutes and Wound Repair Procedures GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each individual
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