Independent Pharmacies: In order to send prescription renewal authorization requests electronically to all eligible prescribers in your area, your pharmacy software must be updated with a valid Surescripts Provider Identifier (SPI) number for each prescriber activated for electronic renewals.
DOCUMENTATION AND CLAIMING REMINDERS BASED ON CHART REVIEWS Medical Necessity and Claiming to Medi-Cal In order to receive reimbursement from Medi-Cal services must meet all Medical Necessity criteria. Medical Necessity has three key criteria: included diagnosis, impairment and interventions. Each element is further defined below. 1.
This process involves a review using Food and Drug Administration (FDA) criteria to make a determination of Medical Necessity, as defined in CRM.015-Medical. Necessity, and approval by the Pharmacy & Therapeutics Committee of the criteria for. prior authorization, as described in RX.003-Prior Authorization Process. The drug, Modafinil (Provigil), is subject to the prior authorization process. II.