5 Video Lessons

Medical Necessity

Medical necessity appeals shape healthcare. Uncontested medical necessity denials result in a subtle shift in treatment availability to the next patient because insurance carriers aim to consistently apply medical necessity limitations. Effective medical necessity appeals, on the other hand, bring to the carrier’s attention necessary variations in care, emerging efficacy issues, and situations that reveal flaws in the day-to-day clinical application of the carrier’s written criteria. For this reason, quality appeal review is critical to each of us. Appeal Solutions has detailed tools for improving medical necessity appeals.

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