Sentences with phrase «coverage determination»
"Coverage determination" refers to the process of making a decision about whether or not an insurance company will pay for a particular medical treatment, prescription drug, or service. It is essentially determining if something is covered by your insurance policy or not. Full definition
The records are reviewed by Claims for making coverage determination under the terms and conditions of the policy purchased.
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Track and triage coverage determination requests submitted from providers and determine if a pharmacist review is required
Insurance terms, definitions and explanations are intended for informational purposes only and do not in any way replace or modify the definitions and information contained in individual insurance contracts, policies or declaration pages, which control coverage determinations.
«Part D sponsors are responsible for making appropriate coverage determinations and ensuring that covered Part D drugs meet the requirements in this section,» CMS wrote back to Scott a week later.
Refer coverage determination requests for specialty drugs to delegated vendor or client for processing
Enter and document coverage determination request decision into the PBM system and notify providers and / or members
Approve coverage determination requests based on defined criteria within the scope of approved protocols or decision trees
Contact providers for additional information to facilitate coverage determination reviews
Insurance terms, definition and explanations are intended for informational purposes only and do not in any way replace of modify the definitions and information contained in individual insurance contracts, policies or declaration pages, which control coverage determinations.
Clarity is crucial when it comes to a coverage determination.
In this transaction, Freddie Mac selects insurance at the loan level and appears to effectively control both pricing and coverage determinations,» Boltansky wrote in a March 13 research note.
Our claims team member could not make a coverage determination for you over the phone since we did not have the medical records / veterinarian notes from that particular visit.
Insurance terms, definitions and explanations are intended for informational purposes only and do not in any way replace or modify the definitions and information contained in individual insurance contracts, policies or declaration pages, which control coverage determinations.
At that time, a coverage determination can be made, as well as a premium price can also be determined.
Clarity is crucial when it comes to a coverage determination.
Track and triage all coverage determination requests for prior authorizations and Medicare Part D recipients Under the direction of Pharmacy Technician, track and triage coverage determination...
Clinical programs may include, but not limited to, coverage determination, appeals, medication therapy management (MTM) strategy, adherence programs, FWA...
Track and triage all coverage determination requests for prior authorizations and Medicare Part D recipients Under the direction of Pharmacy Technician,...