QUICK REFERENCE GUIDE - UPMC Health Plan

Behavioral Health - UPMC Health Plan

Behavioral Health This section of the UPMC Health Plan Provider Manual contains information pertinent to Behavioral Health Network Providers who …

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Workers’ Compensation Provider Billing Guidelines ...

code meets the requirements. ... Workers’ Compensation Provider Billing Guidelines A. Send an e-mail to the Bureau explaining what you have done to determine

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Welcome and Key Contacts - Quality Health …

Welcome and Key Contacts – Chapter A Welcome and Key Contacts A.2 Welcome A.3 Provider OnLine A.4 UPMC Health Plan Website A.5 How to Use This Manual . A.7 . Key Contacts . A.8 Table A1 -

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Out-of-Network Care Claim Form - UPMC Health …

Out-of-Network Care Claim Form • Both sides of this form must be completed. Incomplete forms will delay payment. • Complete sections 1-5. Have the doctor who treated you complete the

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UPMC Health Plan (Commercial) UPMC HEALTH …

UPMC Health Plan (Commercial) UPMC Health Plan www.upmchealthplan.com © 2014 – 2015 All rights reserved. e 1 UPMC HEALTH PLAN (Commercial) C.2 Employer Group Products at a Glance

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UPMC for Kids - UPMC Health Plan

UPMC for Kids e 1 UPMC for Kids D.2 At a Glance D.4 Covered Benefits D.13 Benefit Exclusions D.14 Member Complaint and Grievance Procedures D.19 Member Rights and …

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G Medical Management5.25.07 - UPMC Health Plan

Medical Management G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify Medical Management G.4 When to Notify Medical Management G.7 Case Management Services

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Claims Procedures - UPMC Health Plan

Claims Procedures UPMC Health Plan www.upmchealthplan.com © 2017. All rights reserved. e 6 Paper Claim Forms CMS-1500 forms These forms are for professional services performed in a provider’s office, hospital, or ancillary

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UPMC Community HealthChoices (Medical …

UPMC Community HealthChoices (Medical Assistance) – Chapter N UPMC Community HealthChoices (Medical Assistance) N.2 At a Glance N.3 Medical Assistance Managed Care in Pennsylvania

Change Pay-to Address/Tax ID Change - UPMC …

A group billing address must be the same for every doctor/office under that tax ID. The billing address can only be changed if it is for the whole group with that same tax ID.

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PRIOR AUTHORIZATION REQUIREMENTS - …

PRIOR AUTHORIZATION REQUIREMENTS AHP – PRIOR AUTHORIZATION REQUIREMENTS April 2018 OUTPATIENT SERVICES (CONT’D) • Electroencephalogram with video • Excess Skin Removal

TP15 Chap 4 Sect 2.1 -- Cosmetic, Reconstructive, …

TRICARE Policy Manual 6010.60-M, April 1, 2015 Chapter 4, Section 2.1 Cosmetic, Reconstructive, And Plastic Surgery - General Guidelines 2 2.1.7 Panniculectomy performed in conjunction with other abdominal or pelvic surgery is covered when medical review determines that the procedure significantly contributes to the safe and

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ASPS Recommended Insurance Coverage Criteria …

Procedure CPT Code Panniculectomy (Functional or Cosmetic) Excision, excessive skin and subcutaneous tissue 15830 (includes lipectomy); abdomen, infraumbilical panniculectomy

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Prior Authorization List 6 19 18 - Paramount Health …

HPV 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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Procedure Code List for Preauthorization for Blue …

1 Dec. 6, 2017 . Procedure Code List for Preauthorization for . Blue Cross and Blue Shield of New Mexico . Medicare Advantage Members Only . Beginning Jan.1, 2018, providers will be required to obtain preauthorization through Blue Cross and

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California Prior Authorization Requirements - …

California Prior Authorization Requirements Health Net of California, Inc. and Health Net Life Insurance Company (Health Net) Direct Network1 HMO (including CommunityCare HMO), Point of Service (POS) Tier 1 and Medicare Advantage (MA) HMO

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Oregon and Washington Prior Authorization …

Oregon and Washington Prior Authorization Requirements Health Net Health Plan of Oregon, Inc. and Health Net Life Insurance Company (Health Net)

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Services that require precertification - IBXTPA

Genetic and genomic tests requiring precertification The following list is a guide to the types of genetic and genomic tests that require precertification.

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