Mediblue Current Process used and how it affects appeals and denials
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Clinical faxed to Manila, Phillipines
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*Faxing Delays
*Failed Faxes
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Manila establishes case in system and scans initial clinical to acute team
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Acute team review
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Denial for lack of medical necessity
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Site of service denial
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Approved
*Documentation supported medical necessity
*On CNS inpatient list
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Additional clinical faxed or called in to acute team
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Approved
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Upheld
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Additional information not considered due to appeal initiation or communication breakdown
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Appeal
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Appeal
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Mediblue Current Process
