Foundation Resources and Grids Summart Text Codes CSIM Navigation Scenario Based
100
Utilization requirements from the plan in order for services rendered to be honored by the plan.
What is a Prior Authorization?
200
An order from the provider for further specialized treatment/services from other providers of the plan.
What is a Referral?
300
An indication from the provider of how the services should be rendered and the intended frequency.
What is a Script/Order?
400
Medically Necessary
Delivered in the appropriate setting
CarePlus Health Plan Benefit
What are the three components that HSO reviews to confirm if an authorization request may be approved?
500
The member is temporarily outside of the plan's service area and requires dialysis.
Out of Network dialysis authorization requests may not be submitted unless?






CPHP Authorizations Module

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