Get What Is A Predetermination Letter

A predetermination letter is a crucial document used to obtain approval from an insurance company for medical procedures or treatments. This guide will assist you in easily completing the form online with clear, step-by-step instructions tailored to your needs.

Follow the steps to complete the form accurately and effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin by filling in the insurance company details at the top, including the company name, address, city, state, and ZIP code. Ensure that you accurately address it to the Pre-Determination Department.
3. Enter the date on which you are preparing the letter. This helps in tracking the request timeline.
4. In the subject line, clearly state the purpose of the letter, such as 'Letter of Medical Necessity'. This helps the recipient quickly identify the intent of the correspondence.
5. Provide the patient's name and identification number in the designated fields. This is critical for referencing the patient’s account.
6. List the dates of service in the specified section to indicate when the treatment is being requested.
7. Include the appropriate ICD-9-CM diagnosis codes that apply to the patient's condition. Accurate coding is important for insurance processing.
8. Write a concise statement requesting approval for the treatment, specifying the medical necessity and outlining how the treatment will benefit the patient.
9. Detail the patient’s medical history, previous treatments, and any relevant symptoms in the sections provided. This information supports your request.
10. Attach any necessary documents, such as medical records or literature helping to establish the medical necessity of the treatment.
11. Conclude the letter with a professional closing, including your name and credentials, ensuring it is appropriate for medical correspondence.
12. Finally, review all filled sections, save your changes, and download, print, or share the completed form as needed.

Complete and submit your predetermination letter online for efficient processing.