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.
The state requires that medical necessity be documented in a beneficiaryâs medical record with supporting documentation such as: Laboratory test results, diagnostic test results, history (past attempts of management if applicable), signs and symptoms, etc.âMedical necessityâ is a fundamental concept underlying the medicaid program. Physicians, dentists, and limited practitioners render, authorize, or prescribe medical services within the scope of their licensure and based on their professional judgment regarding medical services needed by an individual.