Medical Necessity Guidelines apply to all fully insured Tufts Health Plan products unless otherwise noted in this guideline or the Member's benefit document. This guideline does not apply to Tufts Health Plan Medicare Preferred or to certain delegated service arrangements. For self-insured plans, ...
When a business is PCI-compliant, it means that that the business reviews and follows the guidelines set forth by the credit card companies to help ensure your credit card information is protected and your personal information is secure. ...
Centers for Medicare & Medicaid Services (CMS) [Website]. National Coverage Decision (NCD) for Osteogenic Stimulators. Retrieved on September 15, 2005 at: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=150.2&ncd_version=2&basket=ncd%3A150%2E2%3A2%3AOsteogenic+St imulators2. Hadju...
Medicare Coverage: In some cases, Medicare may cover the cost of custom shoe inserts if they are deemed medically necessary. Private Insurance Policies: Certain private insurance policies may also provide coverage for custom shoe inserts, depending on the individual’s plan. Veterans Affairs Benefits:...
This Clinical Policy Bulletin addresses rituximab for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of rituximab (Rituxan), rituximab-abbs (Truxima), rituximab-arrx (Riabni), rituximab-pvvr (Ruxience), or rituximab / ...
Medical necessity review of infertility drugs by Aetna Specialty Pharmacy Guideline Management may be bypassed for infertility ART drugs that are for use with infertility medical procedures if the infertility procedure has been approved for coverage under the member’s Aetna medical benefit plan. During...
dical Necessity.]]>Discusses the effort of a regional medical center in Northern New York to develop a medical necessity strategy that will meet customer satisfaction with the use of Meditech, a primary hospital information system. Devise of a cyclic flow chart to define the core responsibilities ...
The increasing linguistic and cultural diversity in the United States underscores the necessity of enhancing healthcare professionals' cross-cultural communication skills. This study focuses on incorporating interpreter and limited-English proficiency (LEP) patient training into the medical and physician assist...
request for five sessions was excessive because the memory deficits were yet identified. Accordingly, the IMR reviewer upheld the UR non-certification, concluding that medical necessity for the treatment request was not established. [LexisNexis Commentary:IMRs such as this, involving work-rela...
Medical Necessity Aetna considers ankle orthoses, ankle-foot orthoses (AFOs), and knee-ankle-foot orthoses (KAFOs) medically necessary (unless otherwise stated) durable medical equipment (DME) according to the criteria set forth below. See background section of this CPB for descriptions of the ...