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.
For Providers: Appeals & Letters of Medical Necessity. Getting patients what they need: Appeals & Letters of Medical Necessity. Learn how to appeal denials, or request prior authorization, for services you prescribe and believe are medically necessary. Medical necessity is a legal, not a medical, definition. This section includes an explanation of medical necessity, directions for writing a letter, and a template for a letter that can be adapted for use appealing medication, equipment, or other service denials. 1  Click here for a brochure explaining how to write a letter of medical necessity.