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InSight Medical Necessity® MEDITECH

“More than 60 percent of healthcare organizations using medical necessity software have reduced claim denials and improved compliance.”
Craneware industry research

Checking Medical Necessity in MEDITECH

Medical Necessity: Integrated vs. Web-based

Our medical necessity tool is also available integrated within MEDITECH MAGIC systems. When you register a patient in MEDITECH, you can use InSight Medical Necessity in the same window to ensure the patient’s ICD-10 and CPT codes are medically necessary. InSight Medical Necessity MEDITECH eliminates the need to jump between programs, because everything stays in MEDITECH. Key features for this product version include:

  • Interfaces with MEDITECH in real-time and provides direct access to medical necessity data.
  • Prompts users to qualify ICD-10 and/or CPT4 codes.
  • Allows users to select entry points of medical necessity submission.
  • Permits verification before the procedure is scheduled in the HIS system.
  • Stores audit trails in the HIS system.


InSight Medical Necessity MEDITECH ensures compliance during the admissions process with Medicare Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs), including APC/OCE edits for inpatient only procedures, incidental only procedures and statutorily non-covered procedures. Issue advanced notification to beneficiaries (ABNs) for potential non-covered services using up-to-date CPT, HCPCS, and ICD-10 code tables in a date sensitive format, all with the convenience of never leaving MEDITECH.

Enter a CPT/HCPCS code or description along with a diagnosis/ICD-10 code or description (searches are available). If the procedure and diagnosis fail medical necessity or CMS guidelines, the system will display an explanation of the failure and enable printing of a medical necessity waiver/ABN when appropriate, using your RVU or Chargemaster fee schedule.

Advance Beneficiary Notification

InSight Medical Necessity MEDITECH informs the registrar, at time of registration, whether or not the procedure will be covered by the payor. For any procedures that fail to meet medical necessity or APC guidelines, the system automatically generates a waiver/ABN, for presentation to the patient/beneficiary. The waiver/ABN may be printed directly from within the MEDITECH system. Your RVU or Chargemaster description/fees coverage amounts are automatically printed on the ABN. You may select the physician and NPI/UPIN from your physician database, which we set up and maintain.


The result of each day’s claims editing activity is available to users for their specified organizational level. The summary report shows the claims submitted, errors encountered, resulting impact charges and gross charges. A detail report of failed claims identifies specific errors for specific patients. Reports can be generated with the following parameters specified for any level in the provider organization:
# Time period
# Physician
# Claim type
# Error type
# Batch number

Also Available as Web-based

MEDITECH is a registered trademark of Medical Information Technology, Inc

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