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Get and Sign UPHP Upper Peninsula Health Plan 2017-2022 Form

Get and Sign UPHP Upper Peninsula Health Plan 2017-2022 Form

Use a dme prior authorization form 2017 template to make your document workflow more streamlined.

All covered benefits must meet CMS and/or MDHHS guidelines. The fee schedules are available at www. uphp.com. HCPCS Code Dx Product Description Quantity Cost Reason for Prior Authorization Out-of-Network Provider Manually Priced Item Hearing Aid s UPHP USE ONLY Covered Not a benefit Diagnosis does not meet Purchase of capped rental UPHP requires PA Over quantity limit Beyond age limit Priced per MDHHS guidelines Manually Priced item Approved Fee Staff AUTHORIZATION Start Date End Date COMMENTS...
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