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<br />Whenever a physician or lipecialty has been customized to identifY certain <br />procedures and/or diagnoses, they will be flagged for review. <br /> <br />[i] D RULE #41 - PROCEDURE AND DIAGNOSIS CODE COMPATIBILITY <br />Whenever a physician bills for a condition unrelated to a procedure which is also <br />being billed for, it is flagged for review. <br /> <br />[!] <br /> <br />D <br /> <br />RULE #42 - PRE-EXISTING CONDITIONS <br />Whenever a physician bills for services which are related to a pre-existing <br />condition for a new enrollee who is still in the grace period for coverage, it will be <br />flagged for review. <br /> <br />m D RULE #43 - SECOND SURGICAL OPINION <br />Whenever a physician bills for a surgical procedure which requires a second <br />surgical opinion, and one has not been performed, it will be flagged for review. <br /> <br />Signature: <br /> <br />Date: AP:r.~~ 14~. 2003 <br /> <br />INTERNAL USE ONLY: <br /> <br />Auto Audit Plan #: <br />