TN 0376 IMMUNODEFICIENCY
PREAUTH		CLAIMS
MIN. CLINICAL SYMPTOMS	MIN. REQUIRED	CRITERIA	DETAILS	% breakup amount - claims	WEIGHTAGE(%) IN CLAIMS AMOUNT	SPECIAL MENTION
RECURRENT INFECTONS, FAILURE TO THRIVE	CLINICAL PHOTO, CBC, CXR,	TOTAL BED DAYS	> 5	20
		DAYS IN ICU				discretion of treating doctor
		DAYS UNDER VENTILATOR SUPPORT
		INVESTIGATIONS	GENERAL WORK UP	30		includes cbc and cxr
			IMMUNOGLOBULIN ASSAY		MANDATORY	ada enzyme levels , iga levels , complement levels .
			BLOOD/URINE CULTURE
		TREATMENT	SUPPORTIVE CARE	50		PACKAGE NAME TO BE REVISED � TO BE MORE SPECIFIC
			IMMUNOGLOBULIN INFUSION		MANDATORY
			TREATMENT OF INFECTIONS