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.
1. Determinations of medical necessity must adhere to the standard of care that applies to the actual direct care and treatment of the patient. 2. Medical necessity is the standard terminology that all health care professionals and entities will use in the review process when determining if medical care is appropriate and essential. 3. Determinations of medical necessity must reï¬ect the efï¬cient and cost-effective application of patient care