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.
Medicare, for example, defines. medically necessaryas: âServices or supplies that are. needed for the diagnosis or treatment of your medical. condition and meet accepted standards of medical. practice.â. â¢ Medical necessity refers to a decision by your health. plan that your treatment, test, or procedure is. necessary for your health or to treat a diagnosed. medical problem.