Important Notice: Our web hosting provider recently started charging us for additional visits, which was unexpected. In response, we're seeking donations. Depending on the situation, we may explore different monetization options for our Community and Expert Contributors. It's crucial to provide more returns for their expertise and offer more Expert Validated Answers or AI Validated Answers. Learn more about our hosting issue here.

Which utilization criteria will DCS use to review medical necessity; Interqual, Milliman or another?

April 26, 2017criteria DCs interqual medical milliman necessity review utilization

0

Posted

Which utilization criteria will DCS use to review medical necessity; Interqual, Milliman or another?

1 Answer

0

Posted

DCS will use only Medicares legal and regulatory documents and policies, such as National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), as guidelines for decision making. We may also choose to utilize clinical support software products as screening tools. If such products are used, the information about this choice will be made available to the community.