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treat all targets as research hypotheses

Additional gap coverage, when offered-mostly with MAPD plans, has been typically limited to generic drugs only (not brands).

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For instance, for ACOs that have participated in the Shared Savings Program over multiple agreement periods, improper payments may impact the amount of a prior savings adjustment to the historical benchmark (if applicable)

Denials also arise when the diagnosis does not justify drug administration, when a more specific HCPCS code exists and should have been used, or when units billed do not match the documented dose