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Medical Necessity vendors

CPS, C-EMR, PM

Last Post by Anonymous 1 second ago

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kbadshah

(@kbadshah)

Posts: 1

New Member

Topic starter

Hello,

Any recommendations on a vendor for medical necessity checking from the EMR? We know there are many solutions for scrubbing claims prior to billing but that is far too late in the process. We want those alerts in the EMR at the time of ordering.

Thank you.

Posted : December 30, 2015 9:14 am

acantu

(@acantu)

Posts: 722

Prominent Member

at the time ordering? That would need some special coding, or interface for ordering to do that. I may be able to help, but would need to know what exactly you need. I do custom application and add-on building for CPS all the time, you can visit my website to find out more about my services at www.aphoenixtech.com

Posted : December 30, 2015 9:38 am

lkeith

(@lkeith)

Posts: 457

Honorable Member

For lab and xrays done here at the clinic, we use EMR Link. For example, when our offices ordered directly into Harvest, Medicare was a given however, we had a few tests for certain commercial carriers that needed medical necessity checking so we were able to flag the carrier to do the validation, but it would only do it on the specific tests that we flagged for that specific carrier. With EMR Link, if you flag an insurance carrier to do validation, you can't specify which tests to validate for that carrier. We use CodeMap to define LCD's and NCDs for lab and radiology.

It would be wonderful if we could have a way to do the same for other procedures within CPS. It would need a way to load the valid dx as well as frequency and if the procedure is deemed experimental.

Posted : December 30, 2015 10:13 am

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