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REVIEW REQUEST ?-Clinical Guideline? Drug- 00001 Anthem UM Services, Inc. Complete form in its entirety and fax to: CT: 203-985-6460 ME & NH: 603-695-7014 Request Date: / / Initial Authorization Request

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What is pre-determination request - anformm?

The pre-determination request (ANFORMM) is a formal submission made to a regulatory body or authority to seek a ruling or opinion on the application of specific laws or regulations to a planned transaction or activity.

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Any individual, organization, or entity that is involved in a planned transaction or activity and wants to obtain clarification on how specific laws or regulations will be applied.

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To fill out a pre-determination request (ANFORMM), you need to gather all relevant information about the transaction or activity, provide a detailed description of the specific issue or question, and submit the request according to the guidelines provided by the regulatory body or authority.

What is the purpose of pre-determination request - anformm?

The purpose of a pre-determination request (ANFORMM) is to obtain clarity and guidance from a regulatory body or authority regarding the application of specific laws or regulations to a planned transaction or activity, allowing the requester to proceed with confidence and compliance.

What information must be reported on pre-determination request - anformm?

A pre-determination request (ANFORMM) typically requires the submission of detailed information about the planned transaction or activity, such as its nature, scope, parties involved, applicable laws or regulations, and any specific issues or questions that need clarification.

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