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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Fax Number: Lovelace Health Plan, Pharmacy Services 4101 Indian School Rd NE Albuquerque,
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What is request a coverage determination?
A request a coverage determination is a formal request made to an insurance provider to determine whether a specific medical service or treatment is covered by the insurance plan.
Who is required to file request a coverage determination?
The insured individual or their healthcare provider is required to file a request for a coverage determination.
How to fill out request a coverage determination?
To fill out a request for a coverage determination, the necessary form must be completed with all relevant information regarding the medical service or treatment being requested.
What is the purpose of request a coverage determination?
The purpose of a request for a coverage determination is to obtain confirmation from the insurance provider on whether a specific medical service or treatment will be covered under the insurance plan.
What information must be reported on request a coverage determination?
The request for a coverage determination must include details such as the patient's personal information, the specific medical service or treatment being requested, and any supporting documentation from the healthcare provider.
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