Question:

If a service has already taken place that was not authorized and you want to deny payment do you need to fax the Tufts Health Plan Medicare Preferred Expedited Organization Determination Approval & NDMC request form? http://www.tuftshealthplan.com/providers/pdf/NDMC_form.pdf

Answer:

No, if the service has already been provided and it had not been authorized you circle it on the ten day claims report and write deny, this will flag it out to Tufts Health Plan claims department and appeal rights will be sent to the member with the reason it was denied.