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.
Medical Necessityâ. shall mean. healthcare services that a Physician, exercising prudent. clinical judgment, would provide to a patient for the purpose. of evaluating, diagnosing or treating an illness, injury, disease. or its symptoms, and that are: a. In accordance with the generally accepted standards of.