Example: dental hygienist

For Precertification

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Procedures, programs and drugs that require precertification

Procedures, programs and drugs that require precertification

www.aetna.com

precertification for the drug and site of care required . Adcetris (brentuximab vedotin, J0791) Aduhelm (aducanumab-avwa, J0172) — precertification for drug and site of care required . Alpha 1-proteinase inhibitor (human) (precertification for the drug and site of care required): Aralast NP (alpha 1-proteinase inhibitor, J0256)

  Precertification

EMPIRE EPO - Welcome to NYC.gov | City of New York

EMPIRE EPO - Welcome to NYC.gov | City of New York

www1.nyc.gov

You are responsible for obtaining precertification from Empire’s Medical Management Program for these services provided in-network. For ambulatory surgery, precertification is required for reconstructive surgery, outpatient transplants and opthalmological or eye related procedures. Precertification is also required

  Precertification, Empires

PCFX Breast Reduction and/or Reconstructive Surgery ...

PCFX Breast Reduction and/or Reconstructive Surgery ...

www.aetna.com

Page 2 of 4 GR-68829-2 (5-20) PCFX Breast Reduction and/or Reconstructive Surgery Precertification Information Request Form About this form You can’t use this form to initiate a precertification request.

  Information, Request, Surgery, Precertification, Reconstructive, Or reconstructive surgery precertification information request

Blue Cross® and Blue Shield® Service Benefit Plan

Blue Cross® and Blue Shield® Service Benefit Plan

www.opm.gov

How to request precertification for an admission or get prior approval for Other services 24 Non-urgent care claims 25 Urgent care claims 25 Concurrent care claims 26 . Coverage information 9 . When you lose benefits 11 . General features of our Standard and Basic Options 13 . We have a Preferred Provider Organization \(PPO\) 13

  Precertification

Your 2022 Prescription Drug List

Your 2022 Prescription Drug List

www.uhc.com

PA Prior Authorization (sometimes referred to as precertification)3 — Requires your doctor to provide information about why you are taking a medication to determine how it may be covered by your plan.4 QL Quanty it Limits — Specifies the largest quantity of medication covered per copayment or in a defined period of time.

  Precertification

Precertification FAX Request Form - CONFIDENTIAL

Precertification FAX Request Form - CONFIDENTIAL

medikeeper.blob.core.windows.net

Precertification FAX Request Form - CONFIDENTIAL To submit a Precertification request, please complete the following information and fax all related clinical information to support the medical necessity of this request to AmeriBen Medical Management: URGENT/ STAT REQUEST(s) must be called into Medical Management:

  Precertification

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