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3 kinds of doctors: generalist, specialist and subspecialist
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Medical Policies
Medical policies are documents that define the plan coverage for technologies, procedures and treatments. The statements of medical necessity in the policies, about whether a technology, procedure, treatment, supply, equipment, drug or other service improves the health outcome of the population for which said technology or treatment was designed are based on scientific evidence, clinical studies and professional opinions from our providers and recognized medical organizations.
Each document displayed on this website is provided for informational purposes only and is not an authorization, explanation of benefits, or contract. Receiving benefits is subject to satisfaction of all terms and conditions of coverage. Medical technology is constantly changing, and we reserve the right to periodically review and update our policies.
| ID | Title | Last Review | Next Review | Description | Access |
|---|---|---|---|---|---|
| 10.001.005 | CIRUGÍA INTENTADA | Aug 22, 2017 | Policy Archived | Se requiere que el médico que realice el procedimiento asigne el código cpt que mejor describa el servicio... | View |
| 10.001.006 | PROCEDIMIENTO INDEPENDIENTE (SEPARATE PROCEDURES) | Aug 22, 2017 | Policy Archived | Un procedimiento independiente se considera para pago cuando: es el único código facturado. no se... | View |
| 10.001.007 | CÓDIGOS U | May 01, 2015 | Policy Archived | La utilización de códigos u se descontinuó en cumplimiento de las directrices de hipaa. para identificar... | View |
| 10.001.008 | PROCEDIMIENTO CON INFORME (BY REPORT) | May 11, 2016 | Policy Archived | En los casos arriba descritos se envía un informe completo del procedimiento, mecanografiado o en letra de... | View |
| 10.001.009 | PROCEDIMIENTOS CON ASTERISCOS EN LA TARIFA | Aug 22, 2017 | Policy Archived | Este concepto de códigos con asterisco se aplica a los procedimientos identificados en el manual de pago del... | View |
| 10.001.010 | AMBULANCIAS Y SERVICIOS DE TRANSPORTACION MÉDICA | May 11, 2016 | Policy Archived | Transportación terrestre de emergencias médicas, son servicios que se considera para pago cuando se cumplen... | View |
| 10.001.013 | Clinical Trials | Nov 14, 2018 | Policy Archived | Triple-s covers for payment all medically necessary and routine services provided in a clinical trial... | View |
| 10.001.014 | TELEMEDICINE | Oct 26, 2023 | Oct 20, 2024 | Numerous states have enacted laws regarding coverage of health care services delivered through telemedicine... | View |
| 10.001.026 | GLUCOMETERS AND SUPPLIES | Nov 14, 2018 | Policy Archived | To be eligible for coverage of related supplies and accessories, and blood glucose monitors, the member must... | View |
| 10.002.001 | CHIROPRACTIC SERVICES | Feb 25, 2022 | Policy Archived | Chiropractic services may be considered medically necessary when all of the following criteria are met:... | View |
| 10.002.002 | SERVICIOS DE SICOLOGOS CLINICOS | Dec 26, 2017 | Policy Archived | Triple-s considera para pago servicios ambulatorios e intrahospitalarios, diagnósticos y terapéuticos, que... | View |
| 10.002.003 | SERVICIOS DE OPTOMETRIA | Aug 22, 2017 | Policy Archived | Se consideran para pago los servicios por optómetras para aquellas pólizas que así lo estipulen. estos... | View |
| 10.002.006 | OSTEOPATHY DOCTORS’ SERVICES | Jul 13, 2022 | Policy Archived | The doctor in osteopathy is authorized to practice osteopathy by the medical licensing and discipline board... | View |
| 10.002.009 | SERVICIOS DE AUDIOLOGIA | May 11, 2016 | Policy Archived | Triple-s cubrirá las pruebas de audiología ambulatoria en niños y adultos cuando éstas sean requeridas y... | View |
| 10.002.010 | Acupuncture | Apr 20, 2022 | Policy Archived | Acupuncture may be considered medically necessary for treatment of the following conditions: 1. chronic... | View |
| 10.002.011 | Alternative and Naturopatic | Mar 18, 2024 | Retired | Triple-s will recognize for payment the services provided by doctors in naturopathy, licensed in puerto rico.... | View |
| 11.001.001 | Autologous blood transfusion (Cell Saver) | Sep 29, 2022 | Policy Archived | The self-transfusion "cell savers" is considered for payment in the following surgeries: a. general... | View |
| 11.001.003 | Anti-CCP Testing for Rheumatiod Arthritis | May 13, 2019 | Policy Archived | Measurement of anti-ccp may be considered medically necessary when used as part of the diagnostic workup for... | View |
| 11.001.004 | MARCADORES DE TUMORES SERICOS PARA CANCER DE MAMA Y GASTROINTESTIL | Sep 21, 2016 | Policy Archived | Determinaciones de marcadores de tumor ca72-4, ca19-9 y ca27.29 no se consideran para pago como una técnica... | View |
| 11.001.005 | In Vitro Chemoresistance and Chemosensitivity Assays | Sep 09, 2021 | Policy Archived | In vitro chemoresistance assays, including, but not limited to, extreme drug resistance assay, are considered... | View |
