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Equested services for medical treatment that needs to be reviewed to determine medical necessity. In order to review your condition for medical necessity in a timely and complete manner, please provide all the following information: Completed enclosed questionnaire All required information as specified in the enclosed questionnaire Please complete the questionnaire, submit a letter of medical necessity and return.

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A predetermination estimate allows you to know in advance what is covered and what your share of the costs will be before you receive a service. Some dental services may be limited or not covered by your plan. It also shows you any deductible or maximums applied.

The main difference between a predetermination and a preauthorization is that the predetermination provides a confirmation that the patient is a covered enrollee of the dental plan and that the treatment planned for the patient is a covered benefit.

This authorization is simply to tell you whether or not the patient's policy covers a specific treatment, but it does not tell you how much coverage they have. Once you receive preauthorization, you can then complete request to receive more specific information about their coverage this is the predetermination.

The main difference between a predetermination and a preauthorization is that the predetermination provides a confirmation that the patient is a covered enrollee of the dental plan and that the treatment planned for the patient is a covered benefit.

A predetermination of benefits is a review by your insurer's medical staff. They decide if they agree that the treatment is right for your health needs.

A predetermination is a formal review of a patient's requested medical care compared to their insurance's medical and reimbursement policies (MGMA). The aim is to determine if the intended care meets medical necessity requirements.

Page 1. “Predetermination” is a review by Blue Cross and Blue Shield of Illinois (BCBSIL) of a doctor's recommended medical procedure, treatment or test to make sure it meets medical necessity requirements. “Medical necessity” means the treatment is appropriate for your symptoms and diagnosis.

It is a free, optional service provided to members to help you make an informed decision about your dental treatment and associated costs. A predetermination is not a guarantee of payment—it is an estimate of what you can expect to owe.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232