What is the checklist that came with the Letter of Request?
The checklist identifies the documents required to determine the medical necessity for the billed service or supply. If a checklist item indicates “if applicable”, you need only submit that document if it is applicable to the claim for which we are requesting information. All other checklist items must be submitted. If you cannot provide a required checklist item, include an explanation of why it is not applicable or the reason it cannot be provided.
