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The process emphasizes submitting only predetermination requests, not scheduling surgery before coverage determination, verifying eligibility and benefits first, and completing all applicable pre-service requirements. Faxing patient information separately, placing the Predetermination Request Form on top of supporting documents, avoiding duplicate submissions, and mailing required photos instead of faxing are required. All clinical documentation supporting medical necessity must be attached.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/instructions-for-submitting-requests-for-predeterminations-meritain-health/288650/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/instructions-for-submitting-requests-for-predeterminations-meritain-health/288650.png","ImageObject",442,249,{"name":88,"@type":89},"Rowan","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-23","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":73},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What should be submitted to avoid delaying the predetermination review?","Question",{"text":108,"@type":109},"Send only predetermination requests. 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Box 853921  \nRichardson, TX 75085-3921  \nFax: 716.541.6735  \nEmail: [servicehelp@meritain.com](servicehelp@meritain.com)  \nPlease note: sending anything other than a predetermination request will delay the review of your information.  \nIMPORTANT PREDETERMINATION REMINDERS  \nPlease note: surgery should not be scheduled prior to determination of coverage.  \n1. Always verify eligibility and benefits first.  \n2. You must also complete any other pre-service requirements, such as preauthorization, if applicable and required.  \n3. All applicable fields are required. If all information is not provided, this may cause a delay in the predetermination process.(Inquiries received without the member/patient’s group number, ID number, and date of birth cannot be completed and maybe returned to you to supply this information. )  \n4. Fax information for each patient separately, using the fax number indicated on the form.  \n5. Always place the Predetermination Request Form on top of other supporting documentation. Please include any additional comments if needed with supporting documentation.  \n7. Do not send in duplicate requests, as this may delay the process.  \n8. If photos are required for review, the photos should be mailed along with the Predetermination Request Form and not faxed. Faxed photos are not legible and cannot be used to make a determination.  \nPlease note that the fact that a guideline is available for any given treatment or that a service or treatment has been preauthorized or predetermined for benefits, is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and plan provisions in effect at the time the service is rendered.  \nPlease note: attach all clinical documentation to support medical necessity.  \n\n| PROVIDER INFORMATION |  |\n| --- | --- |\n| REQUESTING PROVIDER | PROVIDER PHONE |\n| PROVIDER ADDRESS | PROVIDER FAX |\n| FACILITY NAME/ADDRESS |  |\n| FACILITY INFORMATION (IF DIFFERENT FROM ABOVE) |  |\n\n\n| MEMBER INFORMATION |  |\n| --- | --- |\n|  |  |\n| MEMBER NAME | MEMBER ID NUMBER |\n| GROUP NAME/NUMBER |  |\n| PATIENT NAME | PATIENT DATE OF BIRTH |\n\n\n| REQUESTED SERVICES: |\n| --- |\n| PROCEDURE CODE(S): |\n| DIAGNOSIS CODE (S): |\n| IN OR OUT PATIENT? |\n\nBariatric Surgeries: please verify guidelines in your patient’s plan or Aetna CPB 0157.","cbCaicpQV4Sxt6dw","https://ap.wps.com/l/cbCaicpQV4Sxt6dw","pdf",30687,"English","# IMPORTANT PREDETERMINATION REMINDERS\n## Submission rules and eligibility checks\n## Provider, member, and requested services fields","[{\"question\":\"What should be submitted to avoid delaying the predetermination review?\",\"answer\":\"Send only predetermination requests. Anything other than a predetermination request will delay the review of the information.\"},{\"question\":\"When can surgery be scheduled?\",\"answer\":\"Do not schedule surgery prior to the determination of coverage.\"},{\"question\":\"How should patient information and photos be handled?\",\"answer\":\"Fax information for each patient separately, and mail photos required for review with the Predetermination Request Form rather than faxing them.\"}]","Instructions for Submitting Requests for Predeterminations - Meritain Health® | PDF",1789633743]