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Ail requests to: Coverage Determination & Exceptions ... If the request is for a transplant medication, was the transplant covered by Medicare? Yes ... Failure to provide clinical documentation supporting
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What is general coverage determination?
General coverage determination is the process of determining what medical services or items are covered by a health insurance plan.
Who is required to file general coverage determination?
Healthcare providers or facilities are required to file general coverage determination with the insurance companies.
How to fill out general coverage determination?
General coverage determination can be filled out by providing the necessary information about the medical service or item, patient information, and insurance details.
What is the purpose of general coverage determination?
The purpose of general coverage determination is to ensure that medical services or items are covered by the insurance plan and to determine the amount of reimbursement.
What information must be reported on general coverage determination?
Information such as procedure codes, diagnosis codes, patient demographics, and insurance policy details must be reported on general coverage determination.
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