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BCBS, UHC, Aetna, and Cigna all require a pre-certification request that includes: the patient's primary diagnosis (F-code), the clinical indicators supporting the level of care, the proposed treatment plan, the expected episode length, and in most cases a physician or psychiatrist attestation of medical necessity

Study 6: Lutz 2010, basic mechanism Citation: Lutz T.A

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These functional markers often move in parallel with biochemical ones and provide meaningful real-world signal about whether the protocol is working

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