Approving Process Sample Clauses

Approving Process. (Process for applications for Services requiring prior approval) The provider will submit a Form 497 (application for approval to provide treatment not covered by the fee schedule) outlining the treatment required and including bitewing and any other appropriate radiographs. This may be accompanied by a letter or computer generated treatment plan. The radiographs will be returned to the Dentist. Having approved the request and assigned an ‘approval number’, the approving dental officer will return the top copy of the form to the provider, forward one copy to the Payment Agent and retain one copy for District Health Board records. The provider must note the approval number on the appropriate claim form: Oral Health Services in Exceptional Circumstances (Adolescents) Treatment Report/Claim Summary. F3.2 Payment Payment for these Services will be based on the information reported by you as outlined in the service specification for oral health services in exceptional circumstances in Clause E5.2 of this Agreement. If you claim under approved exceptional circumstances you cannot also claim under the capitated normal claiming system in that Calendar Year. The payment you will receive, per Service provided, will be in accordance with the table below. Item Code Price (GST excl.) 2011/2012 price Consultation, including examination and diagnosis, prophylaxis, advice on dental care and any special tests and bitewing radiographs considered necessary CON5 $62.05 One surface posterior fillings (molars and pre-molars) FIL1 $62.56 Periapical X-rays RAD1 $9.79 Fissure sealant FIS1 $21.66 Any other Services provided under the service specification for oral health services in exceptional circumstances will be priced in accordance with the tables in clause F2.
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Related to Approving Process

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