RECOMMENDER REQUIRED PRE-AUTH GROUP A PRE-AUTH GROUP B
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1 DESCRIPTION COMPLETION OF MEDICAL CERTIFICATE OHC Feb-15 $38.20 N CORRECTIVE LASER EYE SURGERY BY AN OPHTHALMOLOGIST (OHC) Jun-11 MD, O YES Y EMPLOYER MAND ASSESSMENT - EMOTIONAL HEALTH PROVIDED BY A PSYCHIATIST (OHC) Nov-13 YES Y AS PER CURRENT POLICY EMPLOYER MAND ASSESSMENT - PHYSICAL HEALTH (OHC) Nov-13 YES Y AS PER CURRENT POLICY EVALUATION OF DISABILITY QUESTIONNAIRE OR FORM 4056 (OHC) Nov N SEE NOTE 9 EXAM/ASSESSMENT SPECIFICALLY TO DETERMINE CORRECTIVE LASER EYE SURGERY (OHC) Jun-11 YES Y EXTRACORPOREAL SHOCK WAVE THERAPY (ESWT) - HIGH ENERGY THERAPY (OHC) Jun-11 MD YES Y SEE NOTE 2 AND 10 FOLLOW UP APPOINTMENT RELATING TO CORRECTIVE LASER EYE SURGERY (OHC) Jun-11 YES Y IMMUNIZATIONS (OHC) Oct-15 N MANDATORY MEDICAL REPORT - (OHC) Apr-13 YES Y MEDICAL SERVICES (LIAISON OFFICERS ONLY) Apr-17 YES Y
2 DESCRIPTION MEDICAL SERVICES (OHC) Jun-11 MD YES Y SEE NOTE 12 MEDICALLY ASSISTED PROCREATION - FEMALE (SHC) Nov-13 MD YES 3 PER LT Y SEE NOTES 4 AND 15 MEDICALLY ASSISTED PROCREATION - MALE (SHC) Nov-13 MD YES 3 PER LT Y AS PER CURRENT POLICY MEMBER REIMBURSEMENT Apr-13 YES Y MIDWIFE SERVICES (SHC) Dec-11 N SEE NOTE 16 PERIODIC HEALTH ASSESSMENT (PHA) (OHC) Nov N RCMP DESIGNATED PHYSICIANS ONLY PERIODIC HEALTH ASSESSMENT (PHA) - (TONAL EXAMINATION ) (OHC) Nov-13 N SEE NOTE 1 PERIODIC HEALTH ASSESSMENT (PHA) - OTHER TESTS (OHC) Nov-13 N PERIODIC HEALTH REASSESSMENT (PHRA) (OHC) Nov-13 YES Y SEE NOTE 8 PHYSICIAN SERVICES - OUT OF CANADA (SHC) Nov-13 YES Y PHYSICIAN SERVICES - OUT-OF-CANADA (OHC) Nov-13 YES Y SEE NOTE 7
3 DESCRIPTION PROVINCIAL SALES TAX (PST) 0PST 01-Jan-11 N REFRACTIVE LENS EXCHANGE (RLE)-(OHC) Nov-11 OP, MD YES Y SEE NOTE 13 REVERSAL VASECTOMY (SHC) Nov-13 MD YES 1/LT Y SEE NOTE 14 SPECIAL ENTITLEMENTS AUTHORIZED BY THE DG OF OHSB - OHC Feb-15 MD YES Y SEE NOTE 2 SPECIAL ENTITLEMENTS AUTHORIZED BY THE DG OF OHSB - SHC Feb-15 MD YES Y SEE NOTE 2 TAXES - GST/HST (GST/HST REGISTRATION NUMBER ) 0TPS 13-Dec-99 N TAXES - GST/HST (GST/HST REGISTRATION NUMBER ) 0GST 01-Jun-10 N TUBAL LIGATION REVERSAL (SHC) Nov-13 MD YES 1/LT N SEE NOTE 14 VAC DISABILITY PENSION APPLICATION ASSESSMENT/REASSESSMENT (OHC) Nov-13 YES Y SEE NOTE 11 WEIGHT MANAGEMENT PROVIDED BY A PHYSICIAN (OHC) Jun-15 YES Y OCCUPATIONAL HEALTH CARE (OHC) AS PER CURRENT POLICY
4 06 Medical Services GENERAL NOTES SPECIAL NOTE: - NOTE OCCUPATIONAL HEALTH CARE - ESWT IS COVERED FOR PLANTAR FASCIITIS AND SHOULDER TENDONITIS WHEN PHYSIOTHERAPY AND CHIROPRACTIC TREATMENTS WERE TRIED AND SHOWN TO BE IN. SPECIAL NOTE: - NOTE SERVICES UP TO A LIVE BIRTH OR AFTER EACH LIVE BIRTH FOR ONE OF THE FOLLOWING OPTIONS DETERMINED BY THE TREATING PHYSICIAN: - 1 STIMULATED CYCLE IVF AND 4 MODIFIED NATURAL CYCLE OR NATURAL CYCLE IVFS; OR - 2 STIMULATED CYCLE IVFS AND 2 MODIFIED NATURAL CYCLE OR NATURAL CYLCLE IVFS; OR - 3 STIMULATED CYCLE IVFS OR 6 MODIFIED NATURAL CYCLE OR NATURAL CYCLE IVFS. SERVICES HAVE TO BE RENDERED IN A CENTRE FOR ASSISTED PROCREATION THAT HOLDS A LICENCE ISSUED IN ACCORDANCE WITH THE REGULATION RESPECTING CLINICAL ACTIVITIES RELATED TO ASSISTED PROCREATION IN THE PROVINCE OR TERRITORY IN WHICH THE MEDICAL PROCEDURES ARE TO BE PERFORMED. SPECIAL NOTE: - NOTE THIS PROCEDURE HAS TO BE ASSESSED BY THE HSO AND APPROVED BY THE OIC UNDER THE OCCUPATIONAL HEALTH CARE LEVEL ONLY. SPECIAL NOTE: - NOTE PLEASE REFERENCE THE MEMORANDUM OF AGREEMENT BETWEEN THE RCMP AND THE FEDERATION OF MEDICAL GENERAL PRACTITIONERS OF QUEBEC. SPECIAL NOTE: - NOTE ONLY TO BE USED BY MEMBERS POSTED IN CANADA. PRE- AUTH AS PER CURRENT POLICY. SPECIAL NOTE: - NOTE RCMP DESIGNATED PHYSICIANS ONLY. AS PER CURRENT POLICY. SPECIAL NOTE: - NOTE THE RCMP WILL HONOUR PROFESSIONAL FEES NOT EXCEEDING THOSE SUGGESTED BY THE PROVINCIAL/TERRITORIAL MEDICAL ASSOCIATION FOR THIS TYPE OF ADMINISTRATIVE SERVICE. SPECIAL NOTE: - NOTE SHOULD OCCUPATIONAL LEVEL OF CARE BE, CLAIM USING OHC FOR MEDICAL SERVICES. AS PER CURRENT POLICY. SPECIAL NOTE: - NOTE AS PER CURRENT POLICY. FOR ACTIVE MEMBERS ONLY. SPECIAL NOTE: - NOTE FOR INTERNAL RCMP USE ONLY. MANDATORY DESCRIPTION TO BE ENTERED BY THE OHSS OFFICE IN THE 'CLAIM MANAGEMENT- AUTHORIZATION S' BOX WITHIN NPS. - AS PER CURRENT POLICY. OCCUPATIONAL HEALTH CARE (OHC). SPECIAL NOTE: - NOTE IN CASES WHERE THE RCMP MEMBER IS NOT A GOOD CANDI FOR LASIK OR PRK. SPECIAL NOTE: - NOTE USUAL AND CUSTOMARY HOSPITAL AND ANESTHETIC FEES ALLOWED. AS PER CURRENT POLICY. SPECIAL NOTE: - NOTE AS PER CURRENT POLICY. SPECIAL NOTE: - NOTE SUPPLEMENTAL HEALTH CARE. MIDWIFE SERVICES WILL BE COVERED IN PROVINCES/TERRITORIES WHERE THEY ARE RECOGNIZED AS A LEGAL AND REGULATED PROFESSION.
5 CHIROPRACTOR CLINICAL AUDIOLOGIST CHIROPODIST CANADIAN NATIONAL INSTITUTE FOR THE BLIND (CNIB) DERMATOLOGIST DIETITIAN ENDOCRINOLOGIST NEUROLOGIST EAR, NOSE AND THROAT SPECIALIST/OTORHINOLARYNGOLOGIST ENTEROSTOMAL THERAPIST GENERAL SURGEON HANDICAPPED DRIVING CENTER HEARING INSTRUMENT PRACTITIONER INTERNAL MEDICINE SPECIALIST MEDICAL ASSISTANT METABOLIC CENTRE MEDICAL DOCTOR (GENERAL PRACTITIONER / MEDICAL SPECIALIST) NEUROLOGIST NURSE PRACTITIONER NEUROSURGEON OPHTHALMOLOGIST OPHTHALMIC TECHNICIAN ORTHOTIST OPTOMETRIST ORTHOPEDIC SURGEON OCCUPATIONAL THERAPIST PODIATRIST PSYCHIATRIST PEDORTHIST PHYSIATRIST PHYSICAL MEDICINE PROSTHETIST PLASTIC SURGEON PHYSIOTHERAPIST PSYCHOLOGIST RHEUMATOLOGIST REGISTERED NURSE RESPIRATORY MEDICINE SPECIALIST RESPIRATORY TECHNOLOGIST SPEECH LANGUAGE PATHOLOGIST SPECIALIST IN REHABILITATION MEDICINE SOCIAL WORKER TRAUMA COUNSELLING UROLOGIST VASCULAR SURGEON WATER INTERPRETATION ANALYSIS C CA CH CI D DI EC EN ES ET GS HD HP IM MA MC MD N NP NS O OC OH OP OS OT P PC PD PH PM PR PS PT PY RH RN RP RT SL SR SW TC U VS WA
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