Policy Name Effective Date Revision Date Next Review Date
Administrative
admin-023 Administrative Denials September 01, 2021 May 26, 2021 May 26, 2022
Admin-002 Behavioral Health Services Level of Care Determination July 28, 2021 July 28, 2021 July 28, 2022
Admin-015 Category III CPT Codes July 01, 2021 June 16, 2021 June 16, 2022
Admin-001 Clinical Criteria for Review Determinations November 30, 2020 November 30, 2020 November 30, 2021
admin-021 Dismissal: Failure to Follow Filing Procedures July 1, 2021 May 26, 2021 May 26, 2022
Admin-003 Medical Services Level of Care Determination November 30, 2020 November 30, 2020 November 30, 2021
Admin-020 Noncovered Behavioral Health-Related Services May 08, 2021 March 08, 2021 March 08, 2022
admin-022 Retrospective Service Reviews September 01, 2021 May 26, 2021 May 26, 2022
Admin-017 Temporary COVID-19 Telemedicine Policy July 28, 2021 July 28, 2021 December 22, 2021
Admin-006 Women’s Health and Cancer Rights Act Clarification June 23, 2021 June 23, 2021 June 23, 2022
Admin-014 Hospital Acquired Conditions and Never Events December 26, 2020 October 26, 2020 October 26, 2021