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What will DCS accept from the provider when supporting a medical necessity denial? If the provider has their own algorithm for medical necessity can this be used to support the decision?

April 26, 2017ALGORITHM DCs denial medical necessity Provider support supporting Used

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What will DCS accept from the provider when supporting a medical necessity denial? If the provider has their own algorithm for medical necessity can this be used to support the decision?

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The provider may submit their algorithms and reasoning supporting the medical necessity, and DCS will review these, but the clinical staff will base their decisions on the patients clinical situation against the background of Medicares rules and regulations.