Medicaid Prior Authorization of Elective OB-GYN Procedure (Use this form prior to admission to the hospital) Fax – 1- 855-427-3747 Effective: 06/1/11

Effective: 06/01/2011 Inpatient Acute Care 2 of 2 CODE RANGE NARRATIVE DESCRIPTION 5856 ESRD 6262 Excessive Menstruation 78341 Failure To Thrive

ÐÏ à¡± á> þÿ ` †¯ þÿÿÿ ¬ &¬ '¬ (¬ )¬ *¬ +¬ ,¬ -¬ .¬ /¬ 0¬ 1¬ 2¬ 3¬ 4¬ 5¬ 6¬ 7¬ 8¬ 9¬ :¬ ;¬ ¬ =¬ >¬ ?¬ @¬ A¬ B¬ C¬ D¬ E ...

May 23, 2012 For Hospitals and Insurers, New Fervor to Cut Costs By REED ABELSON Giselle Fernandez is only 17 but she has had more than 50 operations since she was born