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Medical Necessity Review (MNR)

Medical Necessity Review (MNR)

Subtitle
Determining medical need

Community Health Partners (CHP) has started a Medicaid Medical Necessity Review Program to assist physicians/medical homes in determining the amount, duration, and scope of a Medicaid service (PCS or In-Home Care Program) as well as Durable Medical Equipment to meet the clinical or health needs of the patient and to support medical need determination.

Role of CHP in the Medical Necessity Review (MNR)

  1. To conduct patient health assessments and provide a recommendation based on Medicaid's Clinical Coverage criteria as to the patient's need, amount, and duration of the service.
  2. To utilize nursing standards of care for a recommendation to the physician/medical home.
  3. To respond within 72 hours to the request for a MNR from physician/medical home.
  4. To seek alternate options of care to meet patient needs and achieve quality of care with cost savings.

Role of Physician/Medical Home

  1. Upon receipt of initial PCS (In-Home Care) or DME referral, fax original form to CHP at 704-865-4614.
  2. Allow 72 hours for the home visit and recommendation to be completed and returned to your office.
  3. PLEASE review the recommendation form and either approve or deny requested service/DME per the nurse's assessment.

If you have any questions regarding the program please contact Caron Tate at Ctate@gfhs.info or 704-874-1928