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INSURANCE
DEPARTMENT OF BANKING AND INSURANCE
DIVISION OF INSURANCE
Health Benefit Plans
Exclusions and Preauthorization Requirements
Actuarial Services
Group Life, Group Health and Blanket Insurance:
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What is exclusions and preauthorization requirements?
Exclusions refer to the specific items or services that are not covered by a health insurance plan. Preauthorization requirements refer to the process of obtaining approval from the insurance provider before receiving certain medical services or treatments.
Who is required to file exclusions and preauthorization requirements?
Healthcare providers and individuals who are covered by a health insurance plan are required to comply with the exclusions and preauthorization requirements.
How to fill out exclusions and preauthorization requirements?
The process for filling out exclusions and preauthorization requirements may vary depending on the specific insurance provider and plan. Generally, individuals or healthcare providers need to submit the necessary forms or documentation required by the insurance provider to request preauthorization or report exclusions.
What is the purpose of exclusions and preauthorization requirements?
The purpose of exclusions and preauthorization requirements is to ensure that healthcare services or treatments meet the criteria for coverage and to control costs for both the insurance provider and the insured individuals.
What information must be reported on exclusions and preauthorization requirements?
The specific information that needs to be reported on exclusions and preauthorization requirements may vary depending on the insurance provider and plan. Generally, it may involve providing details about the medical service or treatment, medical diagnosis, healthcare provider, and any supporting documentation.
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