Letter Explanation Home
C0001
- Case Management Introduction, Contact Made
A Case Management nurse has previously made
contact with you, and is providing additional information
about the Case Management program.
What to do:
No immediate reply is necessary, but you should keep your
case manager informed of the status of any of your health
needs. Review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact your case manager at 1-800-862-3338.
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C0002 - Case Management
Introduction, No Previous Contact
This letter is an introduction to our Case
Management program,
and an invitation for you to participate in the program.
What to do:
A Nurse Case Manager should be making contact with you in
the near future. If you don't hear from the case manager
shortly, please call our office to make contact and start
receiving the benefits of Case Management. Meanwhile, review
the information provided, and any additional information
found on this website. If you have any questions or concerns,
contact us at 1-800-862-3338.
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C0003
- Case Management Introduction, Unable to Contact
This letter is an introduction to our Case
Management program,
and an invitation for you to participate in the program.
One of our Nurse Case Manager's has attempted to make contact,
but has been unable to reach you.
What to do:
Please call our office to make contact and start receiving
the benefits of Case Management. Meanwhile, review the information
provided, and any additional information found on this website.
If you have any questions or concerns, contact us at 1-800-862-3338.
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C0004
- Case Management Introduction for Dependant, Previously
Contacted
A Case Management nurse has previously made
contact with you regarding Case Management for your dependant,
and is
providing additional information about the Case
Management program.
What to do:
No immediate reply is necessary, but you should keep your
case manager informed of the status of any of your dependant's
health needs. Review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact your case manager at 1-800-862-3338.
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C0005
- Case Management Introduction for Dependant, No Previous
Contact
This letter is an introduction to our Case
Management program,
and an invitation for your dependant to participate in the
program.
What to do:
A Nurse Case Manager should be making contact with you in
the near future. If you don't hear from the case manager
shortly, please call our office to make contact and start
receiving the benefits of Case Management for your dependant.
Meanwhile, review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact us at 1-800-862-3338.
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C0006
- Case Management Introduction for Dependant, Unable to Contact
This letter is an introduction to our Case
Management program,
and an invitation for your dependant to participate in the
program. One of our Nurse Case Manager's has attempted to
make contact, but has been unable to reach you.
What to do:
Please call our office to make contact and start receiving
the benefits of Case Management for your dependant. Meanwhile,
review the information provided, and any additional information
found on this website. If you have any questions or concerns,
contact us at 1-800-862-3338.
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C0007
- Case Management Participant, Unable to Contact
You have previously enrolled in our Case
Management program,
but unfortunately your Nurse Case Manager has been unable
to reach you.
What to do:
Please call our office to inform your case manager of any
needs you may have. Meanwhile, review the information provided,
and any additional information found on this website. If
you have any questions or concerns, contact your case manager
at 1-800-862-3338.
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C0008
- Living Well with a Chronic Condition Introduction for Dependant,
No Previous Contact
This letter is an introduction to our Living
Well with a Chronic Condition program, and an invitation for your dependant
to participate in the program.
What to do:
A Nurse Specialist should be making contact with you in
the near future. If you don't hear from the Nurse Specialist
shortly, please call our office to make contact and start
receiving the benefits of Living Well with a Chronic Condition
for your dependant. Meanwhile, review the information provided,
and any additional information found on this website. If
you have any questions or concerns, contact us at 1-800-862-3338.
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C0009
- Living Well with a Chronic Condition Introduction for Dependant,
Previously Contacted
A Nurse Specialist has previously made contact with you
regarding Living Well with a Chronic Condition for your dependant,
and is providing additional information about the program.
What to do:
No immediate reply is necessary, but you should keep your
Nurse Specialist informed of the status of any of your dependant's
health needs. Review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact your case manager at 1-800-862-3338.
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C0010
- Living Well with a Chronic Condition Introduction, Contact
Made
A Nurse Specialist has previously made contact with you,
and is providing additional information about the Living
Well with a Chronic Condition program.
What to do:
No immediate reply is necessary, but you should keep your
Nurse Specialist informed of the status of any of your health
needs. Review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact your case manager at 1-800-862-3338.
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C0011
- Living Well with a Chronic Condition Introduction, No Previous
Contact
This letter is an introduction to our Living
Well with a Chronic Condition program, and an invitation for you to participate
in the program.
What to do:
A Nurse Specialist should be making contact with you in
the near future. If you don't hear from the Nurse Specialist
shortly, please call our office to make contact and start
receiving the benefits of Living Well with a Chronic Condition.
Meanwhile, review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact us at 1-800-862-3338.
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C0012
- Living Well with a Chronic Condition Introduction for Dependant
This letter is an introduction to our Living
Well with a Chronic Condition program, and an invitation for your dependant
to participate in the program.
What to do:
A Nurse Specialist should be making contact with you in
the near future. If you don't hear from the Nurse Specialist
shortly, please call our office to make contact and start
receiving the benefits of Living Well with a Chronic Condition
for your dependant. Meanwhile, review the information provided,
and any additional information found on this website. If
you have any questions or concerns, contact us at 1-800-862-3338.
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C0013
- Living Well with a Chronic Condition Introduction
This letter is an introduction to our Living
Well with a Chronic Condition program, and an invitation for you to participate
in the program.
What to do:
A Nurse Specialist should be making contact with you in
the near future. If you don't hear from the Nurse Specialist
shortly, please call our office to make contact and start
receiving the benefits of Living Well with a Chronic Condition.
Meanwhile, review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact us at 1-800-862-3338.
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C0014
- Living Well with a Chronic Condition Participant, Unable
to Contact
You have previously enrolled in our Living
Well with a Chronic Condition program, but unfortunately your Nurse Specialist
has been unable to reach you.
What to do:
Please call our office to inform your Nurse Specialist of
any needs you may have. Meanwhile, review the information
provided, and any additional information found on this website.
If you have any questions or concerns, contact your case
manager at 1-800-862-3338.
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C0015
- Healthy Mother Baby Case Management Introduction
This letter is an introduction to our Healthy
Mother Baby Case Management program, and an invitation for you to participate
in the program.
What to do:
A Nurse Case Manager should be making contact with you in
the near future. If you don't hear from the case manager
shortly, please call our office to make contact and start
receiving the benefits of Healthy Mother Baby Case Management.
Meanwhile, review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact us at 1-800-862-3338.
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C0016
- Perinatal Case Management Introduction, Unable to Contact
This letter is an introduction to our Perinatal Case
Management program, and an invitation for you to participate in the
program. One of our Nurse Case Manager's has attempted to
make contact, but has been unable to reach you.
What to do:
Please call our office to make contact and start receiving
the benefits of Perinatal Case Management. Meanwhile, review
the information provided, and any additional information
found on this website. If you have any questions or concerns,
contact us at 1-800-862-3338.
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C0017
- Perinatal Case Management Introduction, Contact Made
A Case Management nurse has previously made
contact with you, and is providing additional information
about the Case Management program.
What to do:
No immediate reply is necessary, but you should keep your
case manager informed of the status of any of your health
needs. Review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact your case manager at 1-800-862-3338.
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C0018
- Information
A Case Management nurse has sent the specific information
you requested.
What to do:
No immediate reply is necessary, but you should keep your
case manager informed of the status of any of your health
needs. Review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact your case manager at 1-800-862-3338.
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H0001
- Healthy Mother Baby Introduction, Contact Made
A Nurse Specialist has previously made contact
with you, and is providing additional information about the
Healthy Mother Baby program.
What to do:
No immediate reply is necessary, but you should keep your
Nurse Specialist informed of the status of any of your health
needs. Review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact your Nurse Specialist at 1-800-862-3338.
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H0002
- Healthy Mother Baby Introduction, No Previous Contact
This letter is an introduction to our Healthy
Mother Baby program, and an invitation for you to participate in the
program.
What to do:
A Nurse Specialist should be making contact with you in
the near future. If you don't hear from the Nurse Specialist
shortly, please call our office to make contact and start
receiving the benefits of the Healthy Mother Baby program.
Meanwhile, review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact us at 1-800-862-3338.
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H0003
- Healthy Mother Baby Program Completion
Your participation in the Healthy
Mother Baby program is
complete. Included is a survey and employer provided incentive.
What to do:
Please complete the survey and mail it back to us. Your
opinions matter to us, and help us shape the program for
future participants. If you have any questions or concerns,
contact your Nurse Specialist at 1-800-862-3338.
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H0004
- Healthy Mother Baby Program Completion
Your participation in the Healthy
Mother Baby program is
complete. Included is a survey regarding your experience
in the program.
What to do:
Please complete the survey and mail it back to us. Your
opinions matter to us, and help us shape the program for
future participants. If you have any questions or concerns,
contact your Nurse Specialist at 1-800-862-3338.
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H0005
- Healthy Mother Baby Participant, Unable to Contact
You have previously enrolled in our Healthy
Mother Baby program, but unfortunately your Nurse Specialist has been
unable to reach you.
What to do:
Please call our office to inform your Nurse Specialist of
any needs you may have. Meanwhile, review the information
provided, and any additional information found on this website.
If you have any questions or concerns, contact your Nurse
Specialist at 1-800-862-3338.
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H0006
- Healthy Mother Baby Participant, Unable to Contact
You have previously enrolled in our Healthy
Mother Baby program, but unfortunately your Nurse Specialist has been
unable to reach you.
What to do:
Please call our office to inform your Nurse Specialist of
any needs you may have. Meanwhile, review the information
provided, and any additional information found on this website.
If you have any questions or concerns, contact your Nurse
Specialist at 1-800-862-3338.
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H0007
- Healthy Mother Baby Introduction, Unable to Contact
One of our Nurse Specialists previously spoke with you about
our Healthy Mother Baby program, but unfortunately has been
unable to reach you recently.
What to do:
Please call our office to make contact and start receiving
the benefits of Case Management. Meanwhile, review the information
provided, and any additional information found on this website.
If you have any questions or concerns, contact us at 1-800-862-3338.
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H0008
- Healthy Mother Baby Welcome
This packet welcomes you to the Healthy
Mother Baby program,
and supplies you with your first set of information.
What to do:
No immediate reply is necessary, but you should keep your
Nurse Specialist informed of the status of any of your health
needs. Review the information provided, and any additional
information found on this website. If you have any questions
or concerns, contact your Nurse Specialist at 1-800-862-3338.
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P0001
- Approval of Medication
Your medication has been approved for medical necessity.
Certain medications require a deeper look to ensure that
they are being prescribed and used appropriately, and our
review staff has looked over your case and found that this
medication is appropriate for your condition.
What to do:
If you are uncertain of your benefits for this medication,
it is always a good idea to check with your benefits company
to find out if the drug is covered, and what your payment
responsibilities may be. The phone number for your benefits
company is in the second to last paragraph, in the sentence "If
you are uncertain of your plan benefits, call…".
Otherwise, you should contact your pharmacy to obtain your
prescription.
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P0002
- Denial of Services
For the specific reasons listed in the letter, the requested
service has been denied for medical necessity. Based on the
information we had received at the time of our decision,
your request could not be approved for medical necessity
under the circumstances.
What to do:
If you have questions regarding the decision, or disagree
with the decision that has been made, contact our office,
and ask to speak with our Appeals Specialist.
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P0003
- Denial of Services
For the specific reasons listed in the letter, the requested
service has been denied for medical necessity. Based on the
information we had received at the time of our decision,
your request could not be approved for medical necessity
under the circumstances.
What to do:
If you have questions regarding the decision, or disagree
with the decision that has been made, contact your benefits
company at the number provided in the final paragraph of
the letter, following the sentence "If you do not agree
with this decision, you have the right to appeal."
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P0004
- Denial of Services, Dependant
For the specific reasons listed in the letter, the service
requested for your dependant has been denied for medical
necessity. Based on the information we had received at the
time of our decision, this request could not be approved
for medical necessity under the circumstances.
What to do:
If you have questions regarding the decision, or disagree
with the decision that has been made, contact our office,
and ask to speak with our Appeals Specialist.
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P0005
- Denial of Services, Dependant
For the specific reasons listed in the letter, the service
requested for your dependant has been denied for medical
necessity. Based on the information we had received at the
time of our decision, this request could not be approved
for medical necessity under the circumstances.
What to do:
If you have questions regarding the decision, or disagree
with the decision that has been made, contact your benefits
company at the number provided in the final paragraph of
the letter, following the sentence "If you do not agree
with this decision, you have the right to appeal."
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P0006
- Incomplete Preauthorization Claim
We have received a request for preauthorization for the
listed service, however we do not have enough information
to make a medical necessity determination at this time. According
to the regulations set out by the Department of Labor, we
must notify you in writing of our request for further information,
and will need to make a determination within the time frame
mentioned in the letter.
What to do:
If you have received this letter, we have already contacted
your doctor's office requesting the needed information, and
will continue to make requests for this information until
it is received, or until the time we are required by law
to make a decision. However, it would also be a good idea
for you to contact your doctor's office to see if they have
sent the clinical information to our office.
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P0007
- Incorrect Preauthorization Claim
We have received a request for preauthorization for the
listed service, however we do not have the correct information
to make a medical necessity determination at this time. Typically
with these instances, a crucial piece of information was
not included with the preauthorization request, and we are
unable to process the request without it. According to the
regulations set out by the Department of Labor, we must notify
you in writing of our request for further information, and
will need to make a determination within the time frame mentioned
in the letter.
What to do:
In the second paragraph of the letter, the particular mistake
associated with your request is noted, and you should follow
the procedures listed within the letter. If the information
is such that you could easily provide it, feel free to do
so. Otherwise, contact your doctor's office and ask that
they provide the requested information. If you have any questions,
feel free to contact our office at 1-800-862-3338.
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P0008
- Denial of Services / Adverse Determination
For the specific reasons listed in the letter, the requested
service has been denied for medical necessity. Based on the
information we had received at the time of our decision,
your request could not be approved for medical necessity
under the circumstances. As required by Department of Labor
regulations, we have included the legal information necessary
for you to appeal this denial of services.
What to do:
If you have questions regarding the decision, or disagree
with the decision that has been made, contact the company
at the number provided under Appeal Rights, section #1. They
will be able answer questions regarding this determination,
and can provide you with the necessary steps and information
to formally appeal if you choose to do so.
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P0009
- Extension Request
Due to extenuating circumstances, as described in your letter,
we need some extra time to complete your request for preauthorization.
By Department of Labor regulations, we are required to provide
written notification of this request.
What to do:
If you have any questions, please call our office at 1-800-862-3338.
Otherwise, there is no need to respond, and we will provide
you with our determination as soon as possible.
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P0010
- Incomplete Preauthorization Claim, Urgent
We have received a request for preauthorization for the
listed service, however we do not have enough information
to make a medical necessity determination at this time. According
to the regulations set out by the Department of Labor, we
must notify you in writing of our request for further information,
and will need to make a determination within the time frame
mentioned in the letter. Due to the urgency of this request,
we are required to make our decision in a very limited time,
and will need any additional information immediately.
What to do:
If you have received this letter, we have already contacted
your doctor's office requesting the needed information, and
will continue to make requests for this information until
it is received, or until the time we are required by law
to make a decision. However, it would also be a good idea
for you to contact your doctor's office to see if they have
sent the clinical information to our office.
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P0011
- Incorrect Preauthorization Claim, Urgent
We have received a request for preauthorization for the
listed service, however we do not have the correct information
to make a medical necessity determination at this time. Typically
with these instances, a crucial piece of information was
not included with the preauthorization request, and we are
unable to process the request without it. According to the
regulations set out by the Department of Labor, we must notify
you in writing of our request for further information, and
will need to make a determination within the time frame mentioned
in the letter. Due to the urgency of this request, we are
required to make our decision in a very limited time, and
will need any additional information immediately.
What to do:
In the second paragraph of the letter, the particular mistake
associated with your request is noted, and you should follow
the procedures listed within the letter. If the information
is such that you could easily provide it, feel free to do
so. Otherwise, contact your doctor's office and ask that
they provide the requested information. If you have any questions,
feel free to contact our office at 1-800-862-3338.
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P0012
- Denial of Services / Adverse Determination, Urgent
For the specific reasons listed in the letter, the requested
service has been denied for medical necessity. Based on the
information we had received at the time of our decision,
your request could not be approved for medical necessity
under the circumstances. As required by Department of Labor
regulations, we have included the legal information necessary
for you to appeal this denial of services. As this was an
urgent request, additional information has been provided
on how to expedite your appeal.
What to do:
If you have questions regarding the decision, or disagree
with the decision that has been made, contact the company
at the number provided under Appeal Rights, section #1. They
will be able answer questions regarding this determination,
and can provide you with the necessary steps and information
to formally appeal if you choose to do so.
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P0013
- Preauthorization Approval
Your preauthorization request has been approved for medical
necessity. This means that your requested procedure or medical
equipment has been reviewed by our staff and found appropriate.
This information has been forwarded to your benefit company
for their consideration.
What to do:
With a preauthorization approval, you have no need to contact
Innovative Care Management or furnish us with any additional
information. If you are already aware that the procedure
or equipment is covered by your plan, you should proceed
as planned by you and your doctor. If you have any questions
regarding payment or coverage, you should contact your benefit
company at the number provided in your letter in the second
to last paragraph, in the sentence stating "If you are
uncertain of your plan benefits, call your plan administrator…".
They will be able to answer any additional questions or concerns
you may have.
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P0014
- Plan Exclusion
Based on the language found in your benefit plan, the requested
procedure or equipment is a plan exclusion. This means that
your benefit plan has no provision to pay for this procedure
or equipment, regardless of a medical necessity determination.
What to do:
Contact your benefit company at the number found in the
last line of the letter, starting "Please contact…",
to check on your benefits for this particular procedure or
item. Your benefit company should also be able to answer
any questions you may have regarding plan exclusions in your
benefits.
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P0015
- Plan Exclusion, Dependant
Based on the language found in your benefit plan, the requested
procedure or equipment for your dependant is a plan exclusion.
This means that your benefit plan has no provision to pay
for this procedure or equipment, regardless of a medical
necessity determination.
What to do:
Contact your benefit company at the number found in the
last line of the letter, starting "Please contact…",
to check on your benefits for this particular procedure or
item. Your benefit company should also be able to answer
any questions you may have regarding plan exclusions in your
benefits.
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P0016
- Plan Exclusion for Routine Screening
Based on the language found in your benefit plan, screening
examinations of this type are a plan exclusion. This means
that your benefit plan has no provision to pay for this procedure
without a specific medical need.
What to do:
Contact your benefit company at the number found in the
last line of the letter, starting "Please contact…",
to check on your benefits for this particular procedure.
Your benefit company should also be able to answer any questions
you may have regarding plan exclusions in your benefits.
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P0017
- Healthy Mother Baby Introduction
Your health plan has notified us of your pregnancy, and
we would like to have you participate in our Healthy
Mother Baby program.
What to do:
Call our office at 1-800-862-3338, and ask to speak to our
Healthy Mother Baby department. Or for more information now,
look at our Healthy Mother Baby program
description on this website.
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P0018
- Healthy Mother Baby Introduction
Your physician has notified us of your pregnancy, and we
would like to have you participate in our Healthy Mother
Baby program.
What to do:
Call our office at 1-800-862-3338, and ask to speak to our
Healthy Mother Baby department. Or for more information now,
look at our Healthy Mother Baby program description on this
website.
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P0019
- Medical Director Review, Additional Information Request;
Dependant
We have received a preauthorization request regarding your
dependant for the listed service, which has been forwarded
to our Medical Director for review. However, the Medical
Director does not have enough information to make a medical
necessity determination at this time. According to the regulations
set out by the Department of Labor, we must notify you in
writing of our request for further information, and will
need to make a determination within the time frame mentioned
in the letter.
What to do:
If you have received this letter, we have already contacted
your dependant's doctor's office requesting the needed information,
and will continue to make requests for this information until
it is received, or until the time we are required by law
to make a decision. However, it would also be a good idea
for you to contact your doctor's office to see if they have
sent the clinical information to our office.
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P0020
- Medical Director Review, Additional Information Request
We have received a request for preauthorization for the
listed service, which has been forwarded to our Medical Director
for review. However, the Medical Director does not have enough
information to make a medical necessity determination at
this time. According to the regulations set out by the Department
of Labor, we must notify you in writing of our request for
further information, and will need to make a determination
within the time frame mentioned in the letter.
What to do:
If you have received this letter, we have already contacted
your doctor's office requesting the needed information, and
will continue to make requests for this information until
it is received, or until the time we are required by law
to make a decision. However, it would also be a good idea
for you to contact your doctor's office to see if they have
sent the clinical information to our office.
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P0021
- Medical Director Review, Additional Information Request;
Dependant
We have received a preauthorization request regarding your
dependant for the listed service, which has been forwarded
to our Medical Director for review. However, the Medical
Director does not have enough information to make a medical
necessity determination at this time.
What to do:
If you have received this letter, we have already contacted
your dependant's doctor's office requesting the needed information,
and will continue to make requests for this information until
it is received, or until the time we are required by law
to make a decision. However, it would also be a good idea
for you to contact your doctor's office to see if they have
sent the clinical information to our office.
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P0022
- Medical Director Review, Additional Information Request
We have received a request for preauthorization for the
listed service, which has been forwarded to our Medical Director
for review. However, the Medical Director does not have enough
information to make a medical necessity determination at
this time.
What to do:
If you have received this letter, we have already contacted
your doctor's office requesting the needed information, and
will continue to make requests for this information until
it is received, or until the time we are required by law
to make a decision. However, it would also be a good idea
for you to contact your doctor's office to see if they have
sent the clinical information to our office.
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P0023
- Unable to Make Determination
For the specific reasons listed in your letter, we were
unable to make a determination on your preauthorization request
at this time.
What to do:
If you have any questions, or would like to restart the
review process with additional information, please call our
office at 1-800-862-3338.
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P0024
- Incomplete Preauthorization Claim
We have received a request for preauthorization for the
listed service, however we do not have enough information
to make a medical necessity determination at this time
What to do:
If you have received this letter, we have already contacted
your doctor's office requesting the needed information, and
will continue to make requests for this information until
it is received, or until the time we are required by law
to make a decision. However, it would also be a good idea
for you to contact your doctor's office to see if they have
sent the clinical information to our office.
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P0025
- Travel Authorization
Your travel request has been approved for medical necessity.
This means that your requested travel has been reviewed by
our staff and found appropriate. This information has been
forwarded to your benefit company for their consideration.
What to do:
With a preauthorization approval, you have no need to contact
Innovative Care Management or furnish us with any additional
information. If you are already aware that the travel is
covered by your plan, you should proceed as planned by you
and your doctor. If you have any additional questions, feel
free to contact our office at 1-800-862-3338.
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