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Effective April 12, 2004, UPMC Health Plan is changing the process that physicians must follow in order to initally authorize (or recertify) coverage for oral nutritional supplements or enteral nutrition therapy. This change applies to treatment for members of all three of the Health Plan's product lines: commercial (UPMC Health Plan and UPMC Health Benefits, Inc.), Medicare (UPMC for Life), and Medicaid (UPMC for You).
For nutritional therapies, physicians must send a certificate of medical necessity to UPMC Health Plan and a written prescription to the vendor of the nutritional therapy. A more detailed description of the process to authorize nutritional therapy, as well as a printable copy of the certificate of medical necessity, are available by following the links below:
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