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Mental Health Parity Non-Quantitative Treatment Limitations (NQTL) documentation

The following documents include standard responses to questions related to Mental Health Parity (MHP) and Non-Quantitative Treatment Limitations (NQTL). This communication is not intended, nor should it be construed, as legal advice. Federal and state laws and regulations are subject to change. The content provided is for informational purposes only and does not constitute medical advice. Decisions about medical care should be made by the doctor and patient. Please note, your plan documents govern all benefit determinations and in the case of conflict with this document your plan controls. Always refer to the plan documents for specific benefit coverage and limitations or call the toll-free member phone number on the ID card.

Medical Necessity (pdf)

Retrospective Review (pdf)

Network Adequacy (pdf)

Pharmacy (pdf)

In-Network Provider Reimbursement (pdf)

Out-of-Network Provider Reimbursement (pdf)

Provider Reimbursement Coding Edits (pdf)