Does the physician have to demonstrate medical necessity when appealing a denied claim or service?
Yes – It is strongly recommended that the physician demonstrate medical necessity when requesting an appeal of a denied claim or service. To establish medical necessity, the physician must clearly describe the condition(s) that justify why the medical procedure should be provided. The more complete and detailed description provided by the physician increases the probability of overturning the denied claim or service.
Related Questions
- I have an outpatient claim that denied with reason code C7050 because the dates of service fall within the dates of service of an inpatient hospital claim. What do I do?
- Why is the physician claim being denied for the global period when the physician has only rendered one service?
- Do claim administrators report medical bills that are denied?
