Musculoskeletal and Pain Management Program …

er emb mm/dd/yyyy - eviCore

Member requires treatment for a different condition Additional care for same condition treated in the last 60 days 2. What is the primary diagnosis?

  Yyyy, Er emb mm dd yyyy

eviCore healthcare and Cigna Integrated Oncology ...

1 eviCore healthcare and Cigna Integrated Oncology Management Program Frequently Asked Questions Who is eviCore healthcare? eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides

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eviCore Radiation Therapy 2019 Guidelines

for Radiation Oncology (ASTRO) Evidence-Based Guidelines, or supported by other acceptable peer-reviewed publications. As such, eviCore will not automatically certify a case based solely on the fact that it

Bone Metastases Radiation Therapy Physician Worksheet (As ...

Bone Metastases Radiation Therapy Physician Worksheet (As of 23 July 2018) 6. What is the reason for treatment? Select all that apply. Extension into viscera or a soft tissue component

Cigna Musculoskeletal Program Interventional Pain ...

1 July 2016 Cigna Musculoskeletal Program Interventional Pain Management . Frequently Asked Questions . Note: Prior authorization requests should only include those codes for the current Interventional

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CT Abdomen and Pelvis - General Imaging Request

1.Date of most recent office visit or other contact with physician: Don't Know Phone call with office staff Phone call with physician Don't know

  Pelvis

CT Chest, Abdomen and Pelvis Imaging Request

Don't Know. Phone call with office staff Phone call with physician Don't Know 3.Is abodminal or pelvic pain present? Yes. No Don't Know: 4.Where is the location of pain?

  Chest, Request, Imaging, Abdomen, Pelvis, Abdomen and pelvis imaging request

er emb mm/dd/yyyy - eviCore

Reduced strength full range Can't move against gravity Hand function. Reduced strength full range Fingertips don't reach palm Normal strength Normal strength Raises with bent knee Unable

  Yyyy, Mm dd yyyy

Cigna Medical Coverage Policies – Radiology Cardiac Imaging

IMAGING STUDY Estimate of Effective Radiation Dose . Sestamibi myocardial perfusion study (MPI) 9-12 mSv PET myocardial perfusion study: Rubidium-82

  Imaging, Perfusion

Radiation Therapy Coding Guidelines - eviCore

viCore e Radiation Therapy Coding Guidelines These guidelines summarize definitions and appropriate use of several CPT® codes. These guidelines are not meant to be all -inclusive, but are meant to be used in conjunction with the other coding resources and AMA Current Procedural Terminology (CPT) code book.

  Coding, Current, Terminology, Procedural, Current procedural terminology

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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Behavior Health Precertification List - Aetna

48.03.815.1 D (3/17) aetna.com Behavioral health precertification list Services requiring precertification*/authorization Behavioral health services requiring

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NEW JERSEY ROPERTY -LIABILITY INSURANCE …

NEW JERSEY PROPERTY-LIABILITY INSURANCE GUARANTY ASSOCIATION DECISION POINT REVIEW PLAN INCLUSIVE OF PRECERTIFICATION REQUIREMENTS Effective Date: 11/15/2017 Please read this information carefully and share it with your health care providers.

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Participating Provider Precertification List

www.aetna.com ©2014 Aetna Inc. 23.03.882.1 A (7/14) General information 1. Precertification and notification are the processes of collecting information before elective inpatient admissions and/or

  Aetna, Precertification

Summary of Benefits and Coverage: What this Plan …

3 of 6 For more information about limitations and exceptions, see the FEHB Plan brochure RI 71-009 at www.nalchbp.org. Common Medical Event Services You May Need

  Services