Payer policy · Definition
Medicare Advantage: Definition
Private plans that replace traditional Medicare and may add prior authorization and network rules Medicare does not impose.
This is a short definition only. The full explanation lives on Medicare Advantage dermatology billing, which is the page to read if you are dealing with this on live claims.
Definition
Coverage must be at least equivalent to traditional Medicare, but utilization management is not, so a service payable under an LCD may still require authorization on an MA product.
For worked examples, payer rules and documentation requirements, read Medicare Advantage dermatology billing. Return to the dermatology billing glossary.
See this term in your own numbers
A free claims audit reviews a de-identified sample of your dermatology claims and returns a line-item findings report.