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Ambetter from Superior HealthPlan
• High-Tech Imaging (i.e., CT, MRI, PET) • Infertility • Obstetrical Ultrasound – Two allowed in a nine month period. Any additional ultrasounds will require prior authorization (unless rendered by a Perinatologist). – For urgent/emergent ultrasounds, treat using best clinical judgment and authorizations will be reviewed retrospectively.
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Tamiflu® Treatment and Prophylaxis Information per CDC ...
www.superiorhealthplan.como Prevention of influenza among residents of institutions, such as long-term care facilities, during influenza outbreaks in the institution. For more information, see IDSA Guidelines website. An emphasis on close monitoring and early initiation of antiviral treatment if fever and/or respiratory symptoms develop is an alternative to
CLAIMS APPEAL PAYMENT RECONSIDERATION & DISPUTE …
www.superiorhealthplan.comPlease complete the following form to help expedite the review of your claims appeal. *Is this a. Request for Reconsideration: you disagree with the original claim outcome (payment amount, denial reason, etc.) Please check if this is the first time you are asking for a review of the claim. ... Farmington, Missouri 63640- 3800 . Author: Jill ...
Medicare Prior Authorization List Effective January 1, 2021
www.superiorhealthplan.comBreast Reduction Capsule Endoscopy Chondrocyte Implants Cochlear Implant Facial Osteotomy Hysterectomy Joint Replacements Mastectomy for Gynecomastia . Medicare Prior Authorization List . Effective January 1, 2021 . ... J7326 GEL-ONE J7327 MONOVISC INJ PER DOSE J7328 HYAL/DERIV GELSYN-3 IA INJ 0.1 MG ...
Claim Adjustment Reason Codes Crosswalk to EX Codes
www.superiorhealthplan.comClaim Adjustment Reason Codes Crosswalk to EX Codes: SHP_20161447 2 Revised April 2016 EX Code Reason Code (CARC) RARC DESCRIPTION TYPE EXCB 15 N596 AUTHORIZATION IS CANCELLED -ERROR IN ENTRY DENY EXHc 15 . N517 DENY: NO AUTHORIZATION ON FILE THAT MATCHES SERVICE(S) BILLED . DENY EXhf . 15 N596 . DENY: NO …
Superior HealthPlan PHONE: o Physical Health: 1-800-218 ...
www.superiorhealthplan.comPhysical Therapy, Occupational Therapy, Speech Therapy Skilled Nursing Visits Private Duty Nursing Abdominal Hysterectomy Bariatric Surgery Circumcision (One year and older) Cardiac Surgeries ENT Services: Nasal/Sinus Endoscopy, Tonsillectomy & Adenoidectomy, Typanostomy, Myringotomy Musculoskeletal Surgical Procedures
Claim Adjustment Reason Codes Crosswalk
www.superiorhealthplan.comex07 7 n517 deny: the procedure code is inconsistent with the patient s sex deny ex09 9 n657 deny: the diagnosis is inconsistent with the patient s age or sex deny ... visit & preven codes are not payable on same dos w o documentation deny ... svc not covered based on age of patient and provider specialty deny
REQUEST FOR PRIOR AUTHORIZATION - Superior HealthPlan
www.superiorhealthplan.comAuthorization Number. Units Dates Authorized. Genetic Testing Type: Pregnant. Yes No. Urgent Request - By checking this box, I certify that this is an urgent request medically necessary treatment, which must be treated within 24 hours.
Wellcare By Allwell
www.superiorhealthplan.comHEDIS/Care gap reviews Financial analysis EHR Utilization Demographic information updates Initiate credentialing of a new practitioner . Confidential and Proprietary Information Membership. Confidential and Proprietary Information ... Supplemental Benefits at a Glance
Ambetter from Superior HealthPlan
www.superiorhealthplan.com• Ambetter from Superior HealthPlan is an HMO Benefit Plan. • Members enrolled in Ambetter must use in- network participating providers, except in the case of emergency services. • If an out-of-network provider is used (except in the case of emergency services), the member will be 100% responsible for all charges.
TX-PAF-5869 - Medicaid Prior Authorization Fax Form
www.superiorhealthplan.comMEDICAID PRIOR AUTHORIZATION FORM Complete and Fax to: 800-690-7030 Behavioral Health Requests/Medical Records: Fax. 866-570-7517. Transplant: Fax. 833-589-1245 . Request for additional units. Existing Authorization. Units. Urgent requests - I certify this request is urgent and medically necessary to treat an injury, illness or condition (not ...
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Obstetrical Ultrasound Policy, Professional
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