Prior Auth Required

11101 - Care Quality Improvement Act of 1986 (as amended, 42 U.S.C. section et seq.)

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / ServiceCare Quality Improvement Act of 1986 (as amended, 42 U.S.C. section et seq.)
Procedure / Service Description

Exceptions - • When PHP has discontinued a contract based on a professional review action, as defined in the Health Care Quality Improvement Act of 1986 (as amended, 42 U.S.C. section 11101 et seq.). • When a provider/practitioner is unwilling to continue to treat the participant or accept PHP’s payment or

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.