Medical Necessity Review

Medical Review Service

• Medical record review based on InterQual or Milliman standards
• Ensure that documentation supports level of care

A clinical review of the medical record is performed utilizing screening tools such as InterQual or Milliman to determine if the services reported were clinically indicated and adequately supported by the documentation in the record. Recommendations are provided regarding whether further evaluation of the level of care is warranted. Ensuring the adequate level of care is reported, is essential in preventing denials and delays in reimbursement.