| Division | Product | Reason Codes || STM Gatekeeper | Medicare | 0373 – Notification on File, Units Maxed (provider liability) || | | 1068 – Requires Referral, Gatekeeper Plan (provider liability) || | | 1081 – Requires Referral, Gatekeeper Plan (provider liability) | Revision History| Date Revised | Page #s | Revision | Author Initials || 07/19/2013 | 8 | Steps 1 and 2: Added, renumbered subsequent steps | GCB || 05/20/2013 | 5 | Table: Updated | TAS || | 15 | Appendix: Deleted | || 05/10/2013 | 1 | Division, STM HMO2: Deleted | KJS || | 2 | Overview, Determine if the referring Physician is Contracted or | || | | Non-contracted: Deleted | || | 8 | Step 2: Updated | || | | Step 3: Deleted; renumbered subsequent steps | ||…
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