Medical Necessity

[LKaf7]

Hello,

Does anyone have a document explaining Medical Necessity related to Behavioral Health? A provider is requesting a document explaining this. I know I can give the definition of medical necessity, but that's all I'm coming up with. Any help is appreciated.

Thanks

 

[Chelle-Lynn]

Here is a possible resource for what you are looking for:

American Society of Addiction Medicine’s The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions

Also here is a link for Blue Cross on Medical Necessity:

https://www11.anthem.com/ca/provider/f1/s0/t0/pw_a115176.pdf

 

[MJ4ever]

Hello,

Does anyone have a document explaining Medical Necessity related to Behavioral Health? A provider is requesting a document explaining this. I know I can give the definition of medical necessity, but that's all I'm coming up with. Any help is appreciated.
C
Thanks

Hi Lkaf,

Check out page 17 about medical necessity: https://www.cms.gov/Outreach-and-Ed.../Mental-Health-Services-Booklet-ICN903195.pdf

Hope that helps,
Barbara

 

[LKaf7]

Thank you!

 

[crichmond]

You can find this one payers website usually...Cigna has a lot of information on it based on which level of care you are needing.