Apr 13, 2022 · It expresses Molina's determination as to whether certain services or supplies are medically necessary, experimental, investigational, or cosmetic for purposes of determining …
If one of your patients is being reviewed using these criteria, you may request a copy of the criteria by calling the Kaiser Permanente Clinical Review staff at 1-800-289-1363 or access …
These criteria are designed to guide both providers and reviewers to the most appropriate diagnostic tests based on a patient’s unique circumstances. In all cases, clinical judgment …
Shoulder Impingement, Non-Traumatic Shoulder Instability, and Glenoid Labral tears – require active conservative therapy and x-ray (orthopedic signs listed below):
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CHPW’s internal clinical coverage criteria developed to assist in medical necessity determinations are based on the evidence-based guidelines and clinical studies in the peer-reviewed …
May 21, 2025 · Effective August 1, 2025, Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. (Kaiser Permanente) are …
Guidance is provided on indications and contraindications for MRI, provider qualifications to perform MRI, specifications of the examination, proper documentation, equipment …
The rates and implications of prior authorizations for advanced ...
Aug 19, 2025 · The purpose of this study is to identify individual- and insurance-related factors that play a role in denial rates for patients undergoing MRIs for shoulder pathologies to …
EVIDENCE TABLES Evidence tables are found separately on the Johns Hopkins Medicine’s Appropriate Use Criteria website.