The Standard Of Medical Necessity Message Board

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Non-Tech : The Standard Of Medical Necessity

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To: 10K a day who started this subject	5/10/2004 12:06:02 AM
From: 10K a day	of 4

Fundamental principle regarding medical necessity of Care: Under Ca Labor Code, S4600 The governing standard is cure OR relieve Source: providerlaw.com UTILIZATION REVIEW GUIDELINES ARE NOTHING MORE THAN MEDICAL NECESSITY FLAGS. LAW PROHIBITS CARRIERS FROM USING CRITERIA AS ABSOLUTE CUT-OFFS. SEE VORSTER V BOWEN 709 F.Supp 934 (D.California 1989) WHEN A PROVIDER SUPPLIES MEDICAL DOCUMENATION WITH CLAIMS, THIS NECESSARILY OVERRIDES THE CRITERIA AS A MATTER OF LAW AND CARRIERS MUST PERFORM AN INDIVIDUALIZED ASSESSMENT BASED ON THE GOVERNING STANDARD OF MEDICAL NECESSITY.

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