Medical Necessity Edits

SCI's AS/400 based Medical Necessity Editing Application alerts the hospital when tests ordered by a physician may not be reimbursed by Medicare or any other provider for which medical necessity edits have been established. 

The criteria for Medical Necessity Editing comes from 3M Medical Necessity Dictionaries which are supplied by 3M Health Information Systems.

The Medical Necessity Editing Application provides the following benefits:
  • The Application is integrated into the McKesson Series 2000 system. Functionality includes Medical Necessity Editing and Advanced Beneficiary Notice (ABN) forms generation (when required), while using standard Series 2000 Registration or Order Entry functions.
  • It includes a database to store all Medical Necessity exceptions encountered during Registration or Order Entry with inquiry and reporting capability.
  • It includes daily and monthly follow up reporting to notify the ordering physician of any patient and exam, test, or service ordered where a Medical Necessity exception occurred.
  • The Application resides on the AS/400 so no additional hardware or interfaces are required.
For more information, contact Michael Walters at (866) 592-4146 or sales@scihg.com.