2016 NIA Clinical Guidelines for Medical Necessity Review ADVANCED IMAGING BCBS WESTERN NYTOC ADVANCED IMAGING GUIDELINES___5 70336 - MRI Temporomandibular Joint (TMJ) ___5 70450 - CT Head/Brain ___7 70480 - CT Orbit (Includes Sella and Posterior Fossa) ___...
Utilization Management The way we review the type and amount of care you're getting. This involves looking at the setting for your care and its medical necessity. Examples may use prior authorization, case management, accompanying reviews or proper discharge planning. V W X Y ZLast...
The way we review the type and amount of care you're getting. This involves looking at the setting for your care and its medical necessity. Examples may use prior authorization, case management, accompanying reviews or proper discharge planning. ...
¾ Diagnosis alone does not establish medical necessity. ¾ "Paint the picture!" by clearly illustrating why the client needs the services. Required Documentation for a Successful Review Remember that D&E recipients must meet Medical Eligibility Criteria for Nursing Facility Level of Care (...
2016 NIA Clinical Guidelines for Medical Necessity Review BLUECROSS BLUESHIELD OF SOUTH CAROLINA AND BLUECHOICE HEALTH PLAN OF SOUTH CAROLINATOC ADVANCED IMAGING GUIDELINES___6 70336 - MRI Temporomandibular Joint (TMJ) ___6 70450 - CT Head/Brain ___8 70480 - CT Orbit (Includes Sella and Post...