Examples of Medical necessity in a sentence
Our Medical Director or other clinical professional will review the requested Healthcare Service in consultation with your medical provider, and if it meets our requirements for Coverage and Medical Necessity, it is Authorized (approved) before those services are provided.
The process of determining that a client meets the Medical Necessity criteria and admitting the client into a substance use disorder treatment program.
With respect to pregnancy, Medical Necessity and Appropriateness shall be deemed to have been demonstrated.
Our notice will include: • Reasons for a Medical Necessity denial including why the requested healthcare service is not Medically Necessary.
As indicated, QCM will consult with the Contractor on continued eligibility, ongoing presence of Medical Necessity, and discharge planning and transition to a lower level of care (if appropriate).