Determination - UC 13: Medical review of determination
Pega Foundation for Healthcare
- Retrieve the case from MDReview@MyHealthPlan workbasket.
- System displays request details.
- Edit Guideline/Policy reference used for reconsideration. The following
Guideline/Policy reference information can be edited:
- Policy Number
- Medical Policy Date
- Medical Policy name
- Guideline number
- Guideline name
- Page number
- Select disposition.
- Edit comments and click Submit to record MD Review’s
disposition.
Refer UC8 for determination resolution communication.
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