31.10.33.04

.04 Documentation Requirements for Structured Diet Programs.

A. The carrier or private review agent acting on behalf of the carrier shall accept any one of the items listed in §B of this regulation as acceptable documentation that the member has completed the structured diet program required by Regulation .03B(4) of this chapter.

B. Acceptable documentation of completion of a structured diet program includes:

(1) Physician notes;

(2) Notes of health care providers, other than physicians;

(3) Receipts of payment for a structured diet program; or

(4) Diet or weight loss logs from a structured diet program.