Determining Medical Necessity
Parkland Community Health Plan uses the following criteria resources for determining Medical Necessity:
- Texas Medicaid Provider Procedures Manual
- InterQual® Criteria Products: Adult and Pediatric (Level of Care: Acute Criteria), Inpatient Rehabilitation (Level of Care), Subacute/SNF (Level of Care), Home Care Q&A (Level of Care), (Level of Care) Outpatient Rehabilitation & Chiropractic, Procedures, Imaging, Specialty Rx Oncology, Specialty Rx Non-Oncology, Molecular Diagnostics, Durable Medical Equipment
- American College of Gynecology Guideline