RECOMMENDER REQUIRED PRE-AUTH GROUP A PRE-AUTH GROUP B

Transcription

1 COMPLETION OF MEDICAL CERTIFICATE OHC Feb-15 N CORRECTIVE LASER EYE SURGERY BY AN OPHTHALMOLOGIST (OHC) Jun-11 MD, O YES Y EMPLOYER MAND ASSESSMENT - EMOTIONAL HEALTH PROVIDED BY A PSYCHIATIST (OHC) Nov-13 YES Y AS R CURRENT POLICY EMPLOYER MAND ASSESSMENT - PHYSICAL HEALTH (OHC) Nov-13 YES Y AS R CURRENT POLICY EVALUATION OF DISABILITY QUESTIONNAIRE OR FORM 4056 (OHC) Nov-13 N SEE NOTE 9 EXAM/ASSESSMENT SCIFICALLY TO DETERMINE CORRECTIVE LASER EYE SURGERY (OHC) Jun-11 YES Y EXTRACORPOREAL SHOCK WAVE THERAPY (ESWT) - HIGH ENERGY THERAPY (OHC) Jun-11 MD YES Y SEE NOTE 2 AND 10 FOLLOW UP APPOINTMENT RELATING TO CORRECTIVE LASER EYE SURGERY (OHC) Jun-11 YES Y IMMUNIZATIONS (OHC) Oct-15 N MANDATORY MEDICAL REPORT - (OHC) Apr-13 YES Y MEDICAL SERVICES (LIAISON OFFICERS ONLY) Apr-17 YES Y

2 MEDICAL SERVICES (OHC) Jun-11 MD YES Y SEE NOTE 12 MEDICALLY ASSISTED PROCREATION - FEMALE (SHC) Nov-13 MD YES 3 R LT Y SEE NOTES 4 AND 15 MEDICALLY ASSISTED PROCREATION - MALE (SHC) Nov-13 MD YES 3 R LT Y AS R CURRENT POLICY MEMBER REIMBURSEMENT Apr-13 YES Y MIDWIFE SERVICES (SHC) Dec-11 N SEE NOTE 16 RIODIC HEALTH ASSESSMENT (PHA) (OHC) Nov-13 N RCMP DESIGNATED PHYSICIANS ONLY RIODIC HEALTH ASSESSMENT (PHA) - (TONAL EXAMINATION ) (OHC) Nov-13 N SEE NOTE 1 RIODIC HEALTH ASSESSMENT (PHA) - OTHER TESTS (OHC) Nov-13 N RIODIC HEALTH REASSESSMENT (PHRA) (OHC) Nov-13 YES Y SEE NOTE 8 PHYSICIAN SERVICES - OUT OF CANADA (SHC) Nov-13 YES Y PHYSICIAN SERVICES - OUT-OF-CANADA (OHC) Nov-13 YES Y SEE NOTE 7

3 REFRACTIVE LENS EXCHANGE (RLE)-(OHC) Nov-11 OP, MD YES Y SEE NOTE 13 REVERSAL VASECTOMY (SHC) Nov-13 MD YES 1/LT Y SEE NOTE 14 SCIAL ENTITLEMENTS AUTHORIZED BY THE DG OF OHSB - OHC Feb-15 MD YES Y SEE NOTE 2 SCIAL ENTITLEMENTS AUTHORIZED BY THE DG OF OHSB - SHC Feb-15 MD YES Y SEE NOTE 2 TAXES - GST/HST (GST/HST REGISTRATION NUMBER ) 0TPS 13-Dec-99 N TAXES - GST/HST (GST/HST REGISTRATION NUMBER ) 0GST 01-Jun-10 N TUBAL LIGATION REVERSAL (SHC) Nov-13 MD YES 1/LT N SEE NOTE 14 VAC DISABILITY NSION APPLICATION ASSESSMENT/REASSESSMENT (OHC) Nov-13 YES Y SEE NOTE 11 WEIGHT MANAGEMENT PROVIDED BY A PHYSICIAN (OHC) Jun-15 YES Y OCCUPATIONAL HEALTH CARE (OHC) AS R CURRENT POLICY

4 06 Medical Services GENERAL NOTES SCIAL NOTE: - NOTE OCCUPATIONAL HEALTH CARE - ESWT IS COVERED FOR PLANTAR FASCIITIS AND SHOULDER TENDONITIS WHEN PHYSIOTHERAPY AND CHIROPRACTIC TREATMENTS WERE TRIED AND SHOWN TO BE IN. SCIAL NOTE: - NOTE SERVICES UP TO A LIVE BIRTH OR AFTER EACH LIVE BIRTH FOR ONE OF THE FOLLOWING OPTIONS DETERMINED BY THE TREATING PHYSICIAN: - 1 STIMULATED CYCLE IVF AND 4 MODIFIED NATURAL CYCLE OR NATURAL CYCLE IVFS; OR - 2 STIMULATED CYCLE IVFS AND 2 MODIFIED NATURAL CYCLE OR NATURAL CYLCLE IVFS; OR - 3 STIMULATED CYCLE IVFS OR 6 MODIFIED NATURAL CYCLE OR NATURAL CYCLE IVFS. SERVICES HAVE TO BE RENDERED IN A CENTRE FOR ASSISTED PROCREATION THAT HOLDS A LICENCE ISSUED IN ACCORDANCE WITH THE REGULATION RESCTING CLINICAL ACTIVITIES RELATED TO ASSISTED PROCREATION IN THE PROVINCE OR TERRITORY IN WHICH THE MEDICAL PROCEDURES ARE TO BE RFORMED. SCIAL NOTE: - NOTE THIS PROCEDURE HAS TO BE ASSESSED BY THE HSO AND APPROVED BY THE OIC UNDER THE OCCUPATIONAL HEALTH CARE LEVEL ONLY. SCIAL NOTE: - NOTE PLEASE REFERENCE THE MEMORANDUM OF AGREEMENT BETWEEN THE RCMP AND THE FEDERATION OF MEDICAL GENERAL PRACTITIONERS OF QUEBEC. SCIAL NOTE: - NOTE ONLY TO BE USED BY MEMBERS POSTED IN CANADA. PRE- AUTH AS R CURRENT POLICY. SCIAL NOTE: - NOTE RCMP DESIGNATED PHYSICIANS ONLY. AS R CURRENT POLICY. SCIAL NOTE: - NOTE THE RCMP WILL HONOUR PROFESSIONAL FEES NOT EXCEEDING THOSE SUGGESTED BY THE PROVINCIAL/TERRITORIAL MEDICAL ASSOCIATION FOR THIS TY OF ADMINISTRATIVE SERVICE. SCIAL NOTE: - NOTE SHOULD OCCUPATIONAL LEVEL OF CARE BE, CLAIM USING OHC FOR MEDICAL SERVICES. AS R CURRENT POLICY. SCIAL NOTE: - NOTE AS R CURRENT POLICY. FOR ACTIVE MEMBERS ONLY. SCIAL NOTE: - NOTE FOR INTERNAL RCMP USE ONLY. MANDATORY DESCRIPTION TO BE ENTERED BY THE OHSS OFFICE IN THE 'CLAIM MANAGEMENT- AUTHORIZATION S' BOX WITHIN NPS. - AS R CURRENT POLICY. OCCUPATIONAL HEALTH CARE (OHC). SCIAL NOTE: - NOTE IN CASES WHERE THE RCMP MEMBER IS NOT A GOOD CANDI FOR LASIK OR PRK. SCIAL NOTE: - NOTE USUAL AND CUSTOMARY HOSPITAL AND ANESTHETIC FEES ALLOWED. AS R CURRENT POLICY. SCIAL NOTE: - NOTE AS R CURRENT POLICY. SCIAL NOTE: - NOTE SUPPLEMENTAL HEALTH CARE. MIDWIFE SERVICES WILL BE COVERED IN PROVINCES/TERRITORIES WHERE THEY ARE RECOGNIZED AS A LEGAL AND REGULATED PROFESSION.

5 CHIROPRACTOR CLINICAL AUDIOLOGIST CHIROPODIST CANADIAN NATIONAL INSTITUTE FOR THE BLIND (CNIB) DERMATOLOGIST DIETITIAN ENDOCRINOLOGIST NEUROLOGIST EAR, NOSE AND THROAT SCIALIST/OTORHINOLARYNGOLOGIST ENTEROSTOMAL THERAPIST GENERAL SURGEON HANDICAPD DRIVING CENTER HEARING INSTRUMENT PRACTITIONER INTERNAL MEDICINE SCIALIST MEDICAL ASSISTANT METABOLIC CENTRE MEDICAL DOCTOR (GENERAL PRACTITIONER / MEDICAL SCIALIST) NEUROLOGIST NURSE PRACTITIONER NEUROSURGEON OPHTHALMOLOGIST OPHTHALMIC TECHNICIAN ORTHOTIST OPTOMETRIST ORTHODIC SURGEON OCCUPATIONAL THERAPIST PODIATRIST PSYCHIATRIST DORTHIST PHYSIATRIST PHYSICAL MEDICINE PROSTHETIST PLASTIC SURGEON PHYSIOTHERAPIST PSYCHOLOGIST RHEUMATOLOGIST REGISTERED NURSE RESPIRATORY MEDICINE SCIALIST RESPIRATORY TECHNOLOGIST SECH LANGUAGE PATHOLOGIST SCIALIST IN REHABILITATION MEDICINE SOCIAL WORKER TRAUMA COUNSELLING UROLOGIST VASCULAR SURGEON WATER INTERPRETATION ANALYSIS C CA CH CI D DI EC EN ES ET GS HD HP IM MA MC MD N NP NS O OC OH OP OS OT P PC PD PH PM PR PS PT PY RH RN RP RT SL SR SW TC U VS WA