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<br />YES <br />E!J <br /> <br />[i] <br /> <br />[!] <br /> <br />[i] <br /> <br />Signature: <br /> <br />NO <br />D <br /> <br />D <br /> <br />D <br /> <br />D <br /> <br />RULE #40 - PROVIDER CUSTOMIZA TION <br />Whenever a physician or specialty has been customized to <br />identifY certain procedures and/or diagnoses, they will be <br />flagged for review. <br /> <br />RULE #41- PROCEDURE AND DIAGNOSIS CODE <br />CaMPA TIBTLITY <br />Whenever a physician bills for a condition unrelated to a <br />procedure which is also being billed for, it is flagged for <br />revIew. <br /> <br />RULE #42 - PRE-EXISTING CONDITIONS <br />Whenever a physician bills for services which are related to a <br />pre-existing condition for a new enrollee who is still in the <br />grace period for coverage, it will be flagged for review. <br /> <br />RULE #43 - SECOND SURGICAL OPINION <br />Whenever a physician bils for a surgical procedure which <br />requires a second surgical opinion, and one has not been <br />performed, it will be flagged for review. <br /> <br />Eric S. Clifford, Mayor <br />Date: April 8, 1996 <br /> <br />ATTEST: <br /> <br />MatXie Cunningham, City Clerk <br /> <br />APPROVED AS TO FORM: <br /> <br />T. K. Haynes, C' <br />INTERNAl. USE ONl. Y: <br />. <br /> <br />Aulo Audit Plan #: <br /> <br />6 <br /> <br />rilL <br /> <br /> <br /> <br />GROU" Dt:NIi.'ITS RISK POOL <br />