How is a medical necessity review performed by CareCore National?
Once the TTE request is registered, a medical necessity determination will be initiated immediately if a prior TTE is on record as having been performed on this member. This medical necessity determination is a limited series of questions that will be asked by CareCore National’s cardiology nursing staff or through a web-based questionnaire. If at the conclusion of this brief review, the request meets criteria for medical necessity, an authorization number will be issued immediately. If faxed information is required, the case will be place in a hold status pending receipt of the requested information. Once all requested information is received and medical necessity has not been demonstrated, the requested is forward to a cardiologist to review for a final medical necessity determination.
