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Grier Template Notice

  • MCC 1 (Denial of New Non-Covered Service before appeal) (doc)
  • MCC 1a (Denial of New Non-Covered Service before appeal - amount not specified) (doc)
  • MCC 1p (Denial of New Non-Covered Service before appeal - prescriber not specified) (doc)
  • MCC 1pa (Denial of New Non-Covered Service before appeal - prescriber amount not identified) (doc)
  • MCC 2 (Initial Denial of New Non-Covered Service upon reconsideration)(doc)
  • MCC 2a (Initial Denial of New Non-Covered Svc upon reconsideration - amount not specified) (doc)
  • MCC 2p (Initial Denial of New Non-Covered Svc upon reconsideration - prescriber not specified) (doc)
  • MCC 2pa (Initial Denial of New Non-Covered Svc upon reconsideration -prescriber amount not specified) (doc)
  • MCC 3 (Termination of Non-Covered Service) (doc)
  • MCC 4 (Denial before appeal or Termination of OTL Service) (doc)
  • MCC 4a (Denial before appeal or Termination of OTL Service - amount not specified) (doc)
  • MCC 4p (Denial before appeal or Termination of OTL Service - prescriber not specified) (doc)
  • MCC 4pa (Denial before appeal or Termination of OTL Service - prescriber amount not specified) (doc)
  • MCC 5 (Initial Denial of OTL Service upon reconsideration) (doc)
  • MCC 5a (Initial Denial of OTL Service upon reconsideration - amount not specified) (doc)
  • MCC 5p (Initial Denial of OTL Service upon reconsideration - prescriber not specified) (doc)
  • MCC 5pa (Initial Denial of OTL Service upon reconsideration - prescriber amount not specified) (doc)
  • MCC 6 (Medical Necessity Denial of New Service before appeal) (doc)
  • MCC 6a (Medical Necessity Denial of New Service before appeal - amount not specified) (doc)
  • MCC 7 (Initial Medical Necessity Denial of New Service upon reconsideration) (doc)
  • MCC 7a (Initial Medical Necessity Denial of New Svc upon reconsideratio-amount not specified) (doc)
  • MCC 8 (Reduction of Service based on Medical Necessity) (doc)
  • MCC 9 (Termination of Service based on Medical Necessity) (doc)
  • MCC 10-11w (Waiver of Right to Stay 2-Bs.Days AFTER notice of Provider-Initiated Termination) (doc)
  • MCC 10 (2 business day advance notice of MCC-Initiated Hospital Discharge) doc)
  • MCC 11r (2-Bs Day Notice of Provider-Initiated Reduction of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available) (doc)
  • MCC 11rf (2-Bs Day Notice of Provider-Initiated Reduction of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available) (doc)
  • MCC 11t (2-Bs Day Notice of Provider-Initiated Termination of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available) (doc)
  • MCC 11tf (2-Bs Day Notice of Provider-Initiated Termination of BHO service for SPMI/SED, I/P psych, residential, or home health service, or service to treat a chronic condition across a continuum when next appropriate level of service not available) (doc)
  • MCC 12 (General Delay) (doc)
  • MCC 12.net (Network Shortage Delay) (doc)
  • MCC 12.N-PCPterm (Non-PCP Termination Delay) (doc)
  • MCC 12.PCP (PCP Change Delay) (doc)
  • MCC 13 (Prior Authorization of Ongoing Service) (doc)
  • P 10 OTL-SA.3 (doc)

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