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UR Agent Report Application and Attestation Form

UR Agent Report Application and Attestation Form

Use a UR Agent Report Application And Attestation Form template to make your document workflow more streamlined.

Preauthorize a service. The Agent will not deny payment for a preauthorized service unless the conditions of Insurance Law 3238 are met. Agent is accredited by the Utilization Review Accreditation Commission URAC YES current certificate attached. NO 6. 136 b 2 ii D 6. The Agent will not transfer liability for the Agent s activities actions or omissions to the health care provider. Provided at an OMH-licensed hospital that participates in insurer s provider network is not subject to concurrent...
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