Individual Plan Summaries
... Complete Upper Denture 60% Partial Upper Denture 60% Crown (porcelain with noble metal) 60% Anesthesia 60% Oral Surgery (removal of impacted tooth; partially bony) 60% Endodontics (molar root canal therapy) 60% Periodontics (osseous surgery; per quadrant) 60% ...
... Complete Upper Denture 60% Partial Upper Denture 60% Crown (porcelain with noble metal) 60% Anesthesia 60% Oral Surgery (removal of impacted tooth; partially bony) 60% Endodontics (molar root canal therapy) 60% Periodontics (osseous surgery; per quadrant) 60% ...
How Do We Get From Here to There
... conditions typically receive health and home care services from different systems, often from multiple providers within each system. As a result, the health care delivery system for those with chronic conditions is complex and confusing; care is often fragmented, less effective than it might otherwi ...
... conditions typically receive health and home care services from different systems, often from multiple providers within each system. As a result, the health care delivery system for those with chronic conditions is complex and confusing; care is often fragmented, less effective than it might otherwi ...
job postings - Asian Health Services
... clinical, quality, and informatics knowledge bases for data validation to create and ensure accuracy of key reports requested. The QIA will also identify targets for clinical workflow transformation, improvements in the coordination of patient services, as well as engage in work-related panel manage ...
... clinical, quality, and informatics knowledge bases for data validation to create and ensure accuracy of key reports requested. The QIA will also identify targets for clinical workflow transformation, improvements in the coordination of patient services, as well as engage in work-related panel manage ...
Dental - Liberty Healthcare Corporation
... services provided to plan members. Negotiated fees typically range from 15-45% below the average fees charged in a dentist’s community for the same or substantially similar services.* * Based on internal analysis by MetLife. Savings from enrolling in a dental benefits plan will depend on various fac ...
... services provided to plan members. Negotiated fees typically range from 15-45% below the average fees charged in a dentist’s community for the same or substantially similar services.* * Based on internal analysis by MetLife. Savings from enrolling in a dental benefits plan will depend on various fac ...
aiting period - Blue Cross and Blue Shield of Louisiana
... The dental benefits described in this Section are available only for Members under 19 years old. Members that were under 19 years old when they enrolled in this Benefit Plan, and during the Policy Year attain age 19, will continue to be covered under this Section until the end of that Policy Year. I ...
... The dental benefits described in this Section are available only for Members under 19 years old. Members that were under 19 years old when they enrolled in this Benefit Plan, and during the Policy Year attain age 19, will continue to be covered under this Section until the end of that Policy Year. I ...
Residential Treatment of Anorexia Nervosa COVERAGE OPTUM™ DETERMINATION
... Summary Plan Descriptions (SPDs) may differ greatly from the standard benefit plans upon which this guideline is based. In the event of a conflict, the enrollee's specific benefit document supersedes these guidelines. All reviewers must first identify enrollee eligibility, any federal or state regul ...
... Summary Plan Descriptions (SPDs) may differ greatly from the standard benefit plans upon which this guideline is based. In the event of a conflict, the enrollee's specific benefit document supersedes these guidelines. All reviewers must first identify enrollee eligibility, any federal or state regul ...
First Smile - EarlyCare Plan
... Apicoectomy - anterior - Only for anterior teeth.................................... 275 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant............... 275 D5110 Complete denture - maxillary.......................................................... ...
... Apicoectomy - anterior - Only for anterior teeth.................................... 275 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant............... 275 D5110 Complete denture - maxillary.......................................................... ...
DEVELOPING FEDERALLY QUALIFIED HEALTH CENTERS INTO COMMUNITY NETWORKS TO IMPROVE
... The agency collaborated with the Montana Primary Care Association to develop a Health Improvement Program (HIP) in which Medicaid pays these health centers $3.75 per member per month to hire care managers to serve beneficiaries. Approximately 90 percent of the Medicaid patients served through this p ...
... The agency collaborated with the Montana Primary Care Association to develop a Health Improvement Program (HIP) in which Medicaid pays these health centers $3.75 per member per month to hire care managers to serve beneficiaries. Approximately 90 percent of the Medicaid patients served through this p ...
Dental Program
... of the more comprehensive procedure. We only pay for covered charges incurred by a covered person while he or she is insured. A covered charge for a crown, bridge or cast restoration is incurred on the date the tooth is first prepared. A covered charge for any other appliance or dental prosthesis is ...
... of the more comprehensive procedure. We only pay for covered charges incurred by a covered person while he or she is insured. A covered charge for a crown, bridge or cast restoration is incurred on the date the tooth is first prepared. A covered charge for any other appliance or dental prosthesis is ...
Procedure Code Review - Multnomah Education Service District
... – NOTE: Referral for treatment of head lice is not claimable if it is not provided by a Medicaid provider, such as when a student is treated solely at home by parents. – Checking head lice as part of regular school policy or procedures for all students is not a claimable activity under MAC. In order ...
... – NOTE: Referral for treatment of head lice is not claimable if it is not provided by a Medicaid provider, such as when a student is treated solely at home by parents. – Checking head lice as part of regular school policy or procedures for all students is not a claimable activity under MAC. In order ...
Methadone Maintenance
... This Coverage Determination Guideline provides assistance in interpreting behavioral health benefit plans that are managed by Optum. This Coverage Determination Guideline is also applicable to behavioral health benefit plans managed by Pacificare Behavioral Health and U.S. Behavioral Health Plan, Ca ...
... This Coverage Determination Guideline provides assistance in interpreting behavioral health benefit plans that are managed by Optum. This Coverage Determination Guideline is also applicable to behavioral health benefit plans managed by Pacificare Behavioral Health and U.S. Behavioral Health Plan, Ca ...
4: Implications for Health Care Providers
... might affect health care providers in Oregon, it is helpful to examine their current involvement in Medicaid as well as the broader climate in which they function. This section describes the supply and distribution of providers in Oregon and, where possible, their financial characteristics and parti ...
... might affect health care providers in Oregon, it is helpful to examine their current involvement in Medicaid as well as the broader climate in which they function. This section describes the supply and distribution of providers in Oregon and, where possible, their financial characteristics and parti ...
Client Eligibility
... understanding with RWHAP-funded programs or other HIV care providers to facilitate the timely linkage of patients to HIV medical care and to accelerate the receipt of an appointment for those who test preliminarily positive. The receiving medical clinic must be informed of the individual's unconfirm ...
... understanding with RWHAP-funded programs or other HIV care providers to facilitate the timely linkage of patients to HIV medical care and to accelerate the receipt of an appointment for those who test preliminarily positive. The receiving medical clinic must be informed of the individual's unconfirm ...
Challenges in Access to Hepatitis C Care
... Fear of side effects based on past treatment regimens (both among those at risk and those who are aware of their infection) ...
... Fear of side effects based on past treatment regimens (both among those at risk and those who are aware of their infection) ...
Substance Use Disorders and the Role of the States
... residential care per treatment—settings where fewer people are treated—compared with the more widely used option of outpatient rehabilitation. Spending has shifted in the last three decades from primarily inpatient care to a combination of outpatient and residential treatment. More recently, spendin ...
... residential care per treatment—settings where fewer people are treated—compared with the more widely used option of outpatient rehabilitation. Spending has shifted in the last three decades from primarily inpatient care to a combination of outpatient and residential treatment. More recently, spendin ...
interpretive guidelines
... The American College of Chest Physicians and the American Academy of Pediatrics endorse the recommendations of the Center for Disease Control and Prevention, Guidelines for Preventing the Transmission of Tuberculosis in Health Care Facilities, (most recent edition). The facility should have in place ...
... The American College of Chest Physicians and the American Academy of Pediatrics endorse the recommendations of the Center for Disease Control and Prevention, Guidelines for Preventing the Transmission of Tuberculosis in Health Care Facilities, (most recent edition). The facility should have in place ...
NBER WORKING PAPER SERIES ESTIMATING THE IMPACT OF MEDICAL INNOVATION:
... results from RACTs may not apply to real-world settings, where adherence to a treatment regimen may be different from in the controlled environment of an RACT. Researchers must therefore use alternative methods and sources of data to measure the benefits of new medical innovations in real world sett ...
... results from RACTs may not apply to real-world settings, where adherence to a treatment regimen may be different from in the controlled environment of an RACT. Researchers must therefore use alternative methods and sources of data to measure the benefits of new medical innovations in real world sett ...
2011-382-1 Brochure-v9
... All benefit maximums are combined Preferred Provider and Out-of-Network, unless noted below. The benefits payable are as defined in and subject to all provisions of this policy and any endorsements thereto. Benefits will be paid up to the maximum benefit for each service as scheduled below. Covered ...
... All benefit maximums are combined Preferred Provider and Out-of-Network, unless noted below. The benefits payable are as defined in and subject to all provisions of this policy and any endorsements thereto. Benefits will be paid up to the maximum benefit for each service as scheduled below. Covered ...
Cost-effectiveness of Preventive Oral Health Care in Medical Offices
... proved access to oral health care for children up to 3 years of age in NC.15 Depending on age, 18% to 39% of children had fluoride applications compared with a national estimate that only 2.5% of children younger than age 4 years had fluoride treatments from dentists in 2006.16 Furthermore, childre ...
... proved access to oral health care for children up to 3 years of age in NC.15 Depending on age, 18% to 39% of children had fluoride applications compared with a national estimate that only 2.5% of children younger than age 4 years had fluoride treatments from dentists in 2006.16 Furthermore, childre ...
Health Care Reform Webinar: Part II What Health Care
... residents covered by Medicaid, who otherwise would be admitted to a SNF. Copays for dual eligibles receiving services in a Medicaid ...
... residents covered by Medicaid, who otherwise would be admitted to a SNF. Copays for dual eligibles receiving services in a Medicaid ...
Cleveland TGA- Ryan White Part A Program EIS Standard of Care
... Cleveland TGA Definition: Counseling individuals with respect to HIV/AIDS; testing (not funded through Ryan White Part A); referrals; other clinical and diagnostic services regarding HIV/AIDS; periodic medical evaluations for individuals with HIV/AIDS; and providing therapeutic measures. The entitie ...
... Cleveland TGA Definition: Counseling individuals with respect to HIV/AIDS; testing (not funded through Ryan White Part A); referrals; other clinical and diagnostic services regarding HIV/AIDS; periodic medical evaluations for individuals with HIV/AIDS; and providing therapeutic measures. The entitie ...
Input letter from Teri Youngdahl, CDA, RDA - 8/26/08 (PDF: 97KB/1 page)
... an OHP without the involvement of Registered Dental Assistants. It would be very difficult for a dentist to run their practice without a Registered Dental Assistant. Four handed dentistry, a doctor with an assistant, is the generally accepted way to practice dentistry. Registered Dental Assistants a ...
... an OHP without the involvement of Registered Dental Assistants. It would be very difficult for a dentist to run their practice without a Registered Dental Assistant. Four handed dentistry, a doctor with an assistant, is the generally accepted way to practice dentistry. Registered Dental Assistants a ...
PrimeWest Health Provider Manual
... taken from a patient from different anatomical sites or different wounds, use the same CPT code, and are tested on the same day. Modifier 90 (reference [outside] laboratory): Identifies laboratory procedures performed by a CLIA-certified lab other than the treating or reporting physician. Modifier 9 ...
... taken from a patient from different anatomical sites or different wounds, use the same CPT code, and are tested on the same day. Modifier 90 (reference [outside] laboratory): Identifies laboratory procedures performed by a CLIA-certified lab other than the treating or reporting physician. Modifier 9 ...
16 Women and Children’s Services E
... accessibility of health care resources as well as to assist Health Choice Arizona members in effectively utilizing these resources. EPSDT services provide comprehensive health care through primary prevention, early intervention, diagnosis, medically necessary treatment, and follow-up care of physica ...
... accessibility of health care resources as well as to assist Health Choice Arizona members in effectively utilizing these resources. EPSDT services provide comprehensive health care through primary prevention, early intervention, diagnosis, medically necessary treatment, and follow-up care of physica ...
health care benefits program ford motor company of canada, limited
... provided confirming the employee's responsibility. ...
... provided confirming the employee's responsibility. ...