To have a procedure or service reviewed for medical necessity before the service is performed, the participant's provider may write a pre-determination letter describing the condition and treatment. The provider's letter must include the enrollee's name and identification number, the patient's name and pertinent medical information. The letter should be sent to BCBSMS. For all inpatient hospital services and any specified diagnostic tests listed in the Medical Case Management and Utilization Review section, contact Acentra at 888-801-1910.
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