Medical Necessity

Validate clinical orders against payer rules for better claims results

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The road to clean claims starts with mapping a strong Medical Necessity course. And staying on course means following the rules of the road, starting with payer rules and including evidence-based clinical standards of care.

The ultimate destination—financial gains and improved efficiencies.

Experian Health's Medical Necessity is the best road to clinical revenue protection. Interfacing with multiple information systems, it seamlessly and automatically checks patient orders against payer rules for medical necessity, frequency, duplication, modifiers and more.

The solution validates an order throughout the process to produce a clean claim billed without fear of denial.

Medical Necessity integrates seamlessly with all EMR, scheduling, and registration systems. Updates are performed automatically and continuously from the charge master file.

Benefits of validating medical necessity with Experian Health

Prevent denied claims

Proactively correct claims before submission to decrease denial rates and increase reimbursements.

Reduce A/R days

Submit claims sooner in the billing process, streamlining your processes.

Reduce manual processes

Receive automated alerts based on Medicare and commercial payer rules.

Seamless integrations

Connect directly with your registration and order systems, integrating seamlessly into existing workflows.

Learn more about medical necessity solutions on our blog

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7 ways to prevent costly claim denials

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Reduce healthcare costs through automation

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How Schneck Medical Center manages denials promptly and with ease

Contact us

If you would like to talk to a representative immediately, please call us at

1 888 661 5657

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