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How to use or fill out predetermination letter for insurance template

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Click ‘Get Form’ to open the predetermination letter for insurance template in our editor.
Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, middle initial, local address, Social Security/Student ID number, daytime phone number, date of birth, and school name.
In the 'Diagnosis' section, provide a detailed description of the medical condition along with appropriate ICD-9 codes. If applicable, include details about any accidental injuries.
Next, complete the 'Recommended Course of Treatment' section. Describe the proposed treatment and include specific CPT codes for any procedures or equipment needed.
Fill in the 'Type of Service/Stay' by selecting one of the options: Inpatient, Ambulatory/Observation, Home Care, DME, Office, or Injectible Request.
Finally, ensure all required medical records are attached as specified in the form before submitting it to Aetna Student Health.

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What is a predetermination letter for insurance?

A recommended clinical review (formerly called predetermination) is a medical necessity review conducted before services are provided. Submitting the request prior to rendering the services is optional and informs the provider and member of situations where a service may not be covered based upon medical necessity.

How to write a pre-determination letter?

When writing to an insurance company, clearly state your claim details, policy number, and the issue at hand. Organize information logically, include dates, and attach supporting documents. Use concise language and avoid emotional statements. Request specific actions or responses and keep copies of all correspondence.

What is a predetermination letter?

The predetermination letter should thoroughly explain the procedure, provide supporting documents like test results and previous treatments, and be submitted by your doctor with their letterhead.

What does predetermination mean for insurance?

A predetermination is a courtesy, where a pre-authorization is a requirement under a plan. Most predetermination requests can take 30 to 45 days, and complete medical history and physical exam documentation should be included.

predetermination letter for health insurance

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