Grier Template Notice

  • MCC 1 Denial of New Non-Covered Service before appeal
  • MCC 1a Denial of New Non-Covered Service before appeal - amount not specified
  • MCC 1p Denial of New Non-Covered Service before appeal - prescriber not specified
  • MCC 1pa Denial of New Non-Covered Service before appeal - prescriber amount not identified
  • MCC 2 Initial Denial of New Non-Covered Service upon reconsideration
  • MCC 2a Initial Denial of New Non-Covered Svc upon reconsideration - amount not specified
  • MCC 2p (Initial Denial of New Non-Covered Svc upon reconsideration - prescriber not specified
  • MCC 2pa Initial Denial of New Non-Covered Svc upon reconsideration -prescriber amount not specified
  • MCC 3 Termination of Non-Covered Service
  • MCC 6 Medical Necessity Denial of New Service before appeal
  • MCC 6a Medical Necessity Denial of New Service before appeal - amount not specified
  • MCC 7 Initial Medical Necessity Denial of New Service upon reconsideration
  • MCC 7a Initial Medical Necessity Denial of New Svc upon reconsideration-amount not specified
  • MCC 8 Reduction of Service based on Medical Necessity
  • MCC 9 Termination of Service based on Medical Necessity
  • MCC 10-11w Waiver of Right to Stay 2-Bs.Days after notice of Provider-Initiated Termination
  • MCC 10 2 business day advance notice of MCC-Initiated Hospital Discharge doc
  • MCC 11pr Post Reduction 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
  • MCC 11pt Post Termination 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
  • 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
  • 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
  • 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
  • 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
  • MCC 12 General Delay
  • MCC 12.net Network Shortage Delay
  • MCC 12.N-PCPterm Non-PCP Termination Delay
  • MCC 12.PCP PCP Change Delay
  • MCC 13 Prior authorization of Ongoing Service