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.
Making up your own definition of medical necessity is not appropriate. The standard definition of medical necessity that HHS, all of the states, and with slight modifications to exclude non-FDA stuff, all of the private payors, is the 1999 AMA Definition of Medical Necessity.