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Whenever a physician or specialty has been customized to identify certain <br />procedures and/or diagnoses, they will be flagged for review. <br />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 />RULE 442 - PRE-EXISTING CONDITIONS <br />Whenever a physician bills for services which aze 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 />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 />Signature: <br />Date: April 8. 2002 <br />USE ONLY: <br />Audit Plan <br />