Foundation | Resources and Grids | Summart Text Codes | CSIM Navigation | Scenario Based |
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Utilization requirements from the plan in order for services rendered to be honored by the plan.
What is a Prior Authorization?
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An order from the provider for further specialized treatment/services from other providers of the plan.
What is a Referral?
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An indication from the provider of how the services should be rendered and the intended frequency.
What is a Script/Order?
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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?
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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?
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