 |
| Prior Authorizations
|
Updated 11/1/07
|
|
For Laredo, Texas Commercial Members - Mercy Oklahoma
Employees -
Fort Scott & Independence Kansas Employees -
Ardmore, Oklahoma Employees -
Fort Smith, Arkansas Employees -
Rogers, Arkansas EmployeesObtain precertification for the following services by calling
1-800-647-2240.
All T-codes require prior
authorization. |
| |
- Medical observation stays greater than 23 hours OR observation billed in conjunction with a surgical code (same-day surgeries)
- All inpatient hospital, skilled nursing, rehabilitation and maternity admissions under the following circumstances:
- Maternity
- All Home Health
- Durable Medical Equipment (DME) over $1000.00 single line item purchase
price. In addition the following items, including but not limited to:
oxygen, CPAP units, TENS units, bone growth or neuromuscular stimulators,
hospital beds, wheelchairs, all custom made items, require prior
authorization.
- Non-emergent ambulance transfers, out of network services, and requests
for benefit exceptions
- Integumentary (skin) System
- Musculoskeletal System
- Respiratory System
- Cardiovascular System
- Digestive System
- Male/Female
- Nervous System
- Eye and Ocular Adnexa
- Radiology
- Medicine
- Cosmetic: Not Covered
- Infertility: Not Covered
- Dental: Not Covered
|
| |
|
|
|