medical necessity criteria, medical necessity documentation, medical necessity guidelines, medical necessity files

Your clients are clamoring for you to include medical necessity content in your software, but your Development resources are tied up in other projects.  Plus, the rules for demonstrating medical necessity are dependent in large part on the clear understanding and application of a live, ever-changing pool of data and information and you don't have the expertise in-house.

Make everyone happy.  Save your firm's time and resources and satisfy your clients at the same time by choosing RulesEngineOnline, a reliable and easily implemented solution.


Working with Essential Medical Necessity Criteria

RulesEngineOnline contains all the data needed to accurately verify and analyze medical necessity criteria. Available data elements that clients can expect as part of the product include:

  • Procedure codes (CPTs)
  • Covered diagnosis codes (ICDs)
  • Non-covered CPT and ICD codes
  • Frequency limitations
  • Age and gender restrictions
  • Policies (LCDs and NCDs published by the Centers for Medicare and Medicaid Services) available to you in HTM or PDF format, or as links
  • Commentary on rule changes provided with every update

Going Beyond Content

With RulesEngineOnline, your host system feeds us the pertinent procedure and diagnosis information. Accessing AccuRules®, we produce a medical necessity criteria result and return it to your host system.

Meeting the Needs of Your Clients

In addition to making timely and accurate updates, MediQuant's RulesEngineOnline content includes access to the actual policies used for the rule files—an invaluable tool for your end users in their medical and administrative duties.

AccuRules updates are also distributed with a summary of the changes made to the medical necessity rules, which is a key feature that helps users stay in tune with what they need to focus on in their medical necessity compliance process.

Where is RulesEngineOnline Being Used?

The MediQuant RulesEngineOnline content is utilized in such places as:

  • Hospitals
  • Physician offices
  • Labs
  • Imaging centers/Radiology
  • Registration/Scheduling
  • Compliance
  • Billing
  • Coding

Software vendors can add value by integrating RulesEngineOnline into their products for:

  • Encoder
  • CDI
  • CAC
  • Eligibility
  • Insurance payers
  • Registration
  • Patient access
  • Claim scrubber

Learn More about RulesEngineOnline

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