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Medical necessity solutions for business partners

Expert content for validation

3M medical necessity solutions for business partners are designed for easy integration and provide medical necessity validation at one or more key points in the enterprise workflow.

Our skilled team of experts produce and deliver monthly medical necessity content. We can provide your customers with timely content for:

  • ICD-9 and ICD-10 National and Local Coverage Decisions (NCDs and LCDs) for Medicare Part A and Part B claims
  • State-specific Medicaid and payer-specific data
  • Supporting ICD-9 diagnostic codes for given HCPCS level 1 and level 2 codes (HCPCS 1 & 2); modifiers; restrictions for frequency, age and gender; non-allowed diagnosis codes for given HCPCS 1 & 2 codes; and noncovered HCPCS 1 & 2

Medical necessity solutions

Integrated content and edits

The 3M™ Grouper Plus Content Services offers cloud-based content that delivers medical necessity checking within your application. Your customers can choose the grouping methodology, editing and reimbursement calculation options for comprehensive high-speed claims processing.

Individual and batched claims processing

The 3M™ Core Grouping Software supports grouping, editing (including medical necessity validation), and reimbursement calculation for individual and batched claims using a Microsoft® Windows® platform.

Embeddable data files

Would you like to leverage your existing health information system applications for a medical necessity solution? Consider embedding the 3M™ Medical Necessity Dictionaries within your existing applications for validation at any point in the customers’ workflow.

Library

  • Fact sheet: (456KB, pdf)
  • Case study: (565KB, pdf)

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