Emdeon Medical Necessity

Emdeon Medical Necessity simplifies the process of evaluating medical necessity for certain procedures with Government and Commercial Payers. Emdeon Medical Necessity helps providers proactively and efficiently reduce write-offs caused by procedures deemed medically unnecessary by third-party payers. With connectivity to the largest Healthcare Revenue and Payment Cycle Network in the industry, responses are generally returned in seconds empowering providers with the information needed to determine next steps for securing payment on procedures before service is rendered.*

In addition to quick response, Emdeon Medical Necessity provides workflow tools to assist staff in the medical necessity evaluation process, including automatically triggering an Advanced Beneficiary Notice (ABN) for patient signature when needed based on information captured. Comprehensive graphical reporting, historical database search capability and tracking of most frequently checked procedure codes gives providers valuable insight to opportunities for physician education, knowledge of most frequent medical necessity failures by Common Procedural Terminology (CPT) code or charge and origin of medical necessity failures by ordering physician.

*Emdeon Medical Necessity is not a guarantee of payment. Final adjudication is determined by the payer.

Features

• Integration with Health Information Systems (HIS)
• Intelligent workflow
• Automatically triggers ABN
• Automatically posts medical necessity information to respective patient account within HIS
• Electronic signature capability
• Network faxing capable
• Direct access to Centers for Medicare and Medicaid Services (CMS) Local Coverage Determination (LCD) policies
• Historical database search capability
• Comprehensive reporting

Benefits

• Proactively reduces write-offs caused by medical necessity failure
• Seamless interface into most information systems
• Screens medical necessity against the most payer connections in the industry
• Maintains Medicare compliance related to ABN requirements
• Increases efficiency and usability with prompts for next steps in process
• 24/7 customer support