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PI 付款政策 33 门诊确定性药物检测 Medicaid、Medicare 目的 此政策旨在确保正确的提供商报销
PI 付款政策 33 门诊确定性药物检测 Medicaid、Medicare 目的 本政策旨在确保正确的提供商报销，仅作为 Molina Healthcare 针对本政策中所述服务的报销政策的一般资源。它并非旨在解决报销情况的每个方面，也不旨在影响护理决策。 本政策是使用全国公认的行业标准和编码原则制定的。如果发生冲突，联邦和州指南（如适用）以及会员的福利计划文件将取代本政策中的信息。此外，如果本政策与提供商合同语言之间存在任何冲突，则以提供商合同语言为准。州、联邦政府或医疗保险和医疗补助服务中心 (CMS) 的适用法律要求可能强制规定保险范围。所包含的参考资料在政策批准时是准确的。 概述 药物测试是物质使用障碍 (SUD)、阿片类药物使用障碍 (OUD)、慢性疼痛和其他医疗状况患者的关键诊断和治疗工具。全国数据显示，过度且不符合循证实践的检测有所增加。为确保药物检测在医学上是必要的，Molina 使用已建立的全国公认的行业标准和编码原则制定了有关门诊药物检测报销的政策。Molina 保留审查已提交的医疗文件的权利，以支持在门诊进行确定性和/或推定性药物检测的必要性。实施此流程是为了评估是否遵循了此政策并满足了标准。当索赔提交给 Molina 时，将对其进行医疗必要性评估。不符合此政策标准的门诊药物检测将不予报销。
2024 Surest标准计划设计-Nevada
Prenatal and Postnatal Care $0 $100 Delivery $625 to $1,375 $4,125 Procedures (Office, Outpatient and Inpatient) $20 to $2,500 Up to $7,000 Bariatric Surgery Not Covered Not Covered Outpatient Surgery $20 to $2,500 Up to $7,000 Other outpatient hospital services $75 to $500 $1,500 Other inpatient hospital stay （INC。从急诊室入院）$ 1,600 $ 4,800康复治疗$ 10至60美元，最高$ 180 $ 180针灸$ 30 $ 30 $ 90脊骨疗法$ 15 $ 15职业治疗$ 10至60美元至60美元$ 180物理治疗$ 10至180美元$ 75至500美元最高$ 1,500常规诊断测试（例如：X射线，实验室，超声）$ 0 $ 0高级测试$ 20至600美元，最高$ 1,800 $ 1,800的医疗疗法和30至2,450美元的$ 1,800款$ 1,000生育治疗未涵盖的心理健康和药物使用障碍
伊利诺伊州HumanaGold®综合Medicare-Medicaid计划预先授权和通知列表，我们更新了我们的预先授权和通知
• Member's Humana ID number, name and date of birth • Date of actual service or hospital admission • Procedure codes, up to 10 maximum per authorization request • Date of proposed procedure, if applicable • Diagnosis codes (primary and secondary), up to 6 maximum per authorization request • Service location • Inpatient location (acute hospital, skilled nursing, hospice) • Outpatient location (telehealth, office, home, off-campus outpatient hospital,校园门诊医院，门诊手术中心[ASC]）•转诊（办公室，校外医院，校园内门诊医院，ASC，其他）•税收识别号（TIN）（TIN）和国家提供者标识符（NPI）和服务设施的服务范围•提供服务•服务型•服务型和NPI•服务•服务型•服务•服务•服务范围•服务•服务•服务•服务•服务•服务范围•服务范围•服务范围•服务范围•服务器/npi•相关临床信息•出院计划
医疗政策在商业计划托管护理（HMO和POS），PPO，EPO和赔偿政策编号：072 R
单击需要事先授权的准脊柱链接程序的链接：▪更改医疗保健标准子集和智能表格和智能表，要求事先使用授权管理器提供商提交授权管理器来提交服务的初始授权请求。授权经理，24/7可用，是审查授权要求，请求授权，提交临床文件，检查现有案例状态并查看/打印决策信的最快方法。对于商业成员，这些请求必须符合医疗政策指南。确保请求准确，快速处理请求：•输入设施的NPI或提供者ID以进行服务的位置。•输入适当的外科医生的NPI或提供者ID作为服务提供商，而不是计费组。授权管理器资源▪有关提示，指南和视频演示，请参阅我们的授权管理器页面。需要事先授权的医疗政策清单
课程vitae sumru bilge-johnson MD
- Program Director of Child Psychiatry Fellowship of the Department of Pediatric Psychiatry & Psychology at Akron Children's Hospital, Jan 2011‐current - Medical Director of Outpatient Clinic (ACH Child Psychiatry Division)2016‐2023 - Associate Program Training Director for Child Psychiatry Fellowship 2010‐ 2011 - Child Psychiatry faculty: outpatient clinic and Partial Hospitalization Program, 2008‐2010 - Child and adolescent精神科医生Sisli Etfal医院（伊斯坦布尔的一家儿童医院）2000-2001-儿童和青少年精神病医生，Irem（Izmit地震受害者艾兹米特康复中心，地震康复中心，Hope，Izmit，Turkey，Turkey）2001年末期 - 2001年 - 儿童和青少年诊所，儿童和青少年的儿童和青少年，儿童和青少年 - 2001年 - 私人诊所 - 1998年的儿童及其Adecial，Adquent，Adquertial，Adquential，Adquential，Adquent，Adquern，伊斯坦布尔医学院，1998-2000
Al淀粉样变性中的自体干细胞移植
TRANSPLANT PROCEDURE ..........................................5 Collection ............................................................................................................. 6 High Dose Chemotherapy .............................................................................. 6 Stem Cell Transplantation .............................................................................. 7 Transplant Timeline ........................................................................................... 8 TRANSPLANT CONSIDERATIONS................................8 Candidates for Treatment .............................................................................. 8 Benefits of an ASCT ......................................................................................... 9 Limitations of an ASCT ...................................................................................10 PREPARING FOR THE PROCEDURE .......................... 10 Pre-Transplant Evaluation and Testing .....................................................10 Inpatient vs. Outpatient Care ......................................................................12 Recommendations for Admission ..............................................................12
个人和家庭ACA计划。 - 犹他州2025
Inpatient Hospitalization (Facility) 50% after Deductible $2,950 per day 50% after Deductible 40% after Deductible 40% after Deductible 50% after Deductible Outpatient Hospital Services (Facility) 50% after Deductible $1,200 50% after Deductible 40% after Deductible 40% after Deductible 50% after Deductible Minor Diagnostic 4 (Lab and X-ray) 50% after Deductible $75 Covered扣除扣除额的100％扣除后$ 20 $ 30
停车与运输
Neurology & Neurosurgery Neuro Pain Clinic Vascular & Cardiac Surgery Cardiology Structurual Heart Cardio-Oncology CardioVascular Genomics Womens Cardiovascular Health Heart Failure & Transplant Cardiac Diagnostic Services Abdominal Transplant Arrhythmia Afib Center Urology Outpatient Rehabilitation Inpatient Rehabilitation Neurodiagnostic Sleep Center Fairfax PET/CT Imaging Inova360̊ConceirgeMedicine
护士从业者计划
Responsibilities: Provide vital mental health services across the health care continuum, including assessment, diagnosis, psychotherapy, and psychopharmacology consultation and management of mental health concerns and psychiatric disorders Population: All ages Settings: Inpatient, outpatient, and emergency settings, substance use recovery, school-based programs, and private practice, as well as primary and acute medical settings providing integrated behavioral health services
Federal Benefits Open Season Highlights 2025 Plan Year
The overall average increase in rates for FEHB for 2025 is 11.2% and the overall average increase in rates for PSHB for 2025 is 6.9%. Cost drivers of our Programs generally align with those in the commercial market. For 2025, these drivers include price increases by providers and suppliers, increased utilization of specialty medications and certain prescription drugs (such as weight loss drugs), increased utilization of outpatient services, and behavioral health care spending.