Medical necessity definition

Medical necessity means that the service or supply is provided by a physician or other health care provider exercising prudent clinical judgment for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and that provision of the service or supply is:

Medical necessity for inpatient care means a requested

Medical necessity means a medical condition of a pregnant woman that, in the reasonable judgment of the physician who is attending the woman, so complicates the pregnancy that it necessitates the immediate performance or inducement of an abortion.

Examples of Medical necessity in a sentence

• No Guarantee of PaymentA Post-Service Medical Necessity Review is not a guarantee of benefits.

• A Post-Service Medical Necessity Review confirms your eligibility, availability of benefits at the time of service, and reviews necessary clinical documentation to ensure the service was Medically Necessary.

• Post-Service Medical Necessity Review does not guarantee payment of benefits by BCBSTX, for instance you may become ineligible as of the date of service or your benefits may have changed as of the date of service.2. Request for Additional InformationThe Post-Service Medical Necessity Review process may require additional documentation from your Provider or pharmacist.

• A Post-Service Medical Necessity Review may be available when a Prior Authorization or Predetermination was not obtained prior to services being rendered.General Provisions Applicable to All Post-Service Medical Necessity Reviews 1.

• Providers should submit appropriate documentation at the time of a Post-Service Medical Necessity Review request.

More Definitions of Medical necessity

Medical necessity or "medically necessary" means or describes

Medical necessity means those substance use treatment services that are reasonable and necessary to protect life, prevent significant illness or disability, or alleviate severe pain through the diagnosis and treatment of a disease, illness or injury consistent with and 42 CFR 438.210(a)(4) or, in the case of EPSDT, services that meet the criteria specified in Title 22, Sections 51303 and 51340.1.

Medical necessity for inpatient care of a minor means a

Medical necessity or “medically necessary” means health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnose a condition; or to prevent a medical condition from occurring;

Medical necessity for inpatient care means a

Medical necessity. “Medically Necessary” / “Medically Appropriate.” With respect to the Medicare and/or Medicare Advantage program, in order for services provided to be deemed Medically Necessary or Medically Appropriate, Covered Services must: (1) be recommended by a PROVIDER who is treating the Member and practicing within the scope of her/his license and (2) satisfy each and every one of the following criteria:

Medical necessity or "medically necessary" means appropriate and necessary health care services which are rendered for any condition which, according to generally accepted principles of good medical practice, requires the diagnosis or direct care and treatment of an illness, injury, or pregnancy-related condition, and are not provided only as a convenience.