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Do Small Group/Individual contracts have to go for a pre-service medical necessity determination?

April 26, 2017contracts determination group individual medical necessity pre-service small

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Do Small Group/Individual contracts have to go for a pre-service medical necessity determination?

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It is not required but we highly recommend the cases be reviewed for medical necessity. This process not only guarantees payment for the radiologist it also protects the member from potentially being balanced billed should the monies be taken back for not meeting medical necessity.