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Whenew:r a physician or specialty has beeo customized to identify certain <br /> procedures and/or diagnoses, they will be flagged for review. <br /> <br />F~ F~ 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 /> F~ F'~ 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 xvho is still in the grace period for coverage, it will be <br /> flagged for review. <br /> <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 /> <br /> Signature: <br /> Date: Apr±~ 16, .200~ <br /> <br /> r~'~P~rAr. U$~ oiqr'Y: <br /> <br /> Auto Audit Plan #: <br /> <br /> <br />