Admin Simp Tools: Prospective Review Guidelines

	Administrative Simplification Tools

Administrative Simplification Tools : Prospective Review Guidelines

Prospective Review Guidelines

Prospective Guidelines for All Products

You can CUSTOMIZE YOUR OWN REPORT of Prospective Review Guidelines. First select the procedure / conditions you'd like to see and then select up to 4 health plans. If you want more than 4 health plans, run this report again.

Step 1: Select your procedures / conditions of interest

3-Wheel Scooter	Abdominoplasty	Acupuncture
Angelchick anti-reflux prosthesis	Apheresis, therapeutic	Apnea Monitor
Augmentation mammoplasty	Autologous Chondrocyte Implantation Carticel	Biofeedback
BiPAP	Blepharoplasty	Bone Density Scans
Bone growth stimulator	Bone marrow transplant	Bone Stimulators (electrical/ultrasonic)
Botox	Breast Pump	Cardiac Rehabilitation
Cataract Surgery	Chemical Dependency - Inpatient	Chemical peel
Chest Compression Vest	Clinical Trials	Cochlear implantation
Collagen Implant - urinary incontinence	Colonoscopy	Compression Garments
Continuous Glucose Monitoring	Cosmetic procedures	CPAP
EGD	Embolization of the Uterine Artery	Enteral Therapy
Gamma Knife	Gastric Bypass	Gastric Stimulator
Genetic TestinG	Glaucoma Screening Scans	Growth hormone therapy
Heart transplant	Heart/lung transplant	Home Health Services
Home Oxygen	Home Phototherapy - Newborn	Hospice Services
Hyperbaric Oxygen	Immune Globulin	Implantable infusion pumps
Implantable neuromuscular stimulators	Infusion Therapy (outpatient) - Treatment, other than Chemotherapy, that is typically infused	Insulin Pump
Interferon	Internal Automatic Cardiac Defibrillator	Islet Cell Transplant
Kidney transplant	Kidney/pancreas transplant	Kyphoplasty
LAUP (Laser assisted uvuloplasty)	Lipectomy	Liver transplant
Lung transplant	Lung volume reduction	Massage Therapy
Mastectomy for gynecomastia	Mastopexy	Medication - High Dollar, e.g. Remicade
Mental Health - Crisis	Mental Health - Inpatient	Mental Health - Outpatient
Mental Health - Partial Hospitalization	Mental Health - Treatment Facility	Naturopathy
Neurodevelopmental rehab services	New Technology	Obesity Surgery (Bariatric)
Obesity treatment	Oral Surgery - Medical	Otoplasty
Oximeter	Palatopharyngoplasty (PPP)	Palatoplasty
Pallidotomy	Pancreas transplant	Pharyngoplasty
Photodynamic Therapy (ophthalmic/esophageal)	Phototherapy for Psoriasis	Positron emisson tomography (PET)
Pressure Reduction mattresses	Procuren	Prolotherapy
Prosorba Column Pheresis	Prostate Seed Implant	Prosthetic Titanium Ribs
Reduction mammoplasty	Repair brow ptosis	Respiratory syncytial virus
Rhinoplasty	Rhizotomy (selective dorsal)	Rhytidectomy
Routine Foot Care	Sacral Nerve Stimulator	Seat lift Mechanism
Signal averaged electrocardiography	Skilled Nursing Facility	Sleep Studies - Facility
Sleep Studies - Home	Special Walkers	Specialty Beds
SPECT	Speech Generation Device	Spider vein procedures
Spinal Manipulation	Stem cell harvesting and/or transplant	Synvisc
TENS Unit	Thermogram (cephalic or peripheral)	Transmyocardial Laser Revascularization
Transplants (except corneal)	TUMT	TUNA
Uvulectomy	Uvulopalatopharyngoplasty (UPP)	Vacuum Assisted Closure
VAXD	Ventricular assist devices	Vertebroplasty
Warm-Up Wound Healing System	Wheelchairs

Step 2: Select health plans (limit four)

	Aetna		First Choice Health Administrators		Group Health		KPS Health Plans
	Molina Healthcare of Washington		Premera Blue Cross		Regence BlueShield		UMP
Information not yet available from the following:
na	Cigna Healthcare	na	Columbia United Providers	na	Community Health Plan of Washington	na	Kaiser Permanente Northwest
na	One Health Plan of Washington	na	PacifiCare, a UnitedHealthcare Company

Important Note:
Before displaying this report, please note that important explanatory information about the contents of the report can be found by clicking on Considerations for Using Processing Tables. This information can be downloaded and then assembled with your customized report.

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» Splitting Claims
» Prospective Review Guidelines
» Inpatient Stay Review
» Health Plan Contacts
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