File GROUP_INSURANCE_PLAN(355.3) Data List
| INSURANCE COMPANY |
IS THIS A GROUP POLICY? |
*GROUP NAME |
*GROUP NUMBER |
IS UTILIZATION REVIEW REQUIRED |
IS PRE-CERTIFICATION REQUIRED? |
EXCLUDE PRE-EXISTING CONDITION |
BENEFITS ASSIGNABLE? |
TYPE OF PLAN |
INDIVIDUAL POLICY PATIENT |
INACTIVE |
AMBULATORY CARE CERTIFICATION |
PLAN FILING TIME FRAME |
PLAN CATEGORY |
ELECTRONIC PLAN TYPE |
PLAN STANDARD FTF |
PLAN STANDARD FTF VALUE |
DATE ENTERED |
ENTERED BY |
DATE LAST VERIFIED |
VERIFIED BY |
DATE LAST EDITED |
LAST EDITED BY |
DATE LAST MATCHED |
LAST MATCHED BY |
COMMENTS |
GROUP NAME |
GROUP NUMBER |
PLAN ID |
BANKING IDENTIFICATION NUMBER |
PROCESSOR CONTROL NUMBER (PCN) |