Greenrain Medical Necessity Checks Help Home

Welcome to Greenrain Medical Necessity Checks User Manual

Greenrain Medical Necessity Checks is a framework to run Medical Necessity Checks (MNC) for e-prescriptions, e-prior requests and e-claims. In fact, providers and payers can use Greenrain MNC to run the checks at any point of care and claims validation. The checks include compatibilities between CPT codes, CPT and ICD10 codes, CPT against gender and age, ICD10 against gender and age and so on. Different versions of CPT and ICD10 are supported depending on particular Health Authority regulation.

Below are just a few scenarios of how Greenrain MNC can be used:

• While the doctor enters the treatment plan into the hospital system, he gets alerts that procedures and diagnoses are not compatible with each other.

• Insurance company runs MNC upon receiving new prior authorizations or claims. The company can make the internal rule to automatically deny the claim if it has certain alerts, e.g. a procedure may not be provided to a male patient of 14 years old.

• The clinic can get MNC alerts in Greenrain Messenger while uploading the claims to Shafafiya or DHPO.