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iNSURANCE COVERAGE
Alabama Viva
Medicaid AL
Arizona Medicaid AZ
Arkansas Medicaid Arkansas
Vantos Health Network
Arkansas Superior Select
Empower Healthcare Solutions
AHS Self-Funded
Georgia Medicaid GA
PeachCare for Kids
Sonder Health Plan
Illinois BCBS IL
Illinois Medicaid
Maryland BCBS Carefirst
Michigan BCBS PPO and PLUS lab networkss
Tennessee BlueCross BlueShield of Tennessee, Inc.
Humana
Ambetter/Celtic Insurance Company
Medicaid TN
Cariten Health Plan
AmeriGroup
BlueCare
BlueCare Plus
Blue Advantage PPO
Health Spring Life and Health
WellCare
Aetna of TN
BCBS PPO and HMO
Harmony Health Plan
TennCare Select
Texas HCSC Insurance Service Corporation
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation (FEP)
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation a Mutual Legal Reserve Company.
Texas Medicaid
Childrens Health Insurance Program (CHIP) of Texas
Children with Special Health Care Needs Services Program (CSHCN) of Texas
Virginia Aetna Better Health
Medicaid Virginia
Cigna MCR Advantage
CareFirst Blue Choice
CareFirst BlueChoice
CareFirst of Maryland, Inc.
Group Hospitalization and Medical Services, Inc. (GHMSI)
HealthKeepers, Inc.
New Jersey Medicaid NJ
New Mexico Medicaid NM
North Carolina Medicaid NC
Sandhills BH
WellCare
Carolina Complete Health Network
VAYA Health
Trillium Health Resource
Partners Heath Mgmt
Alliance Health Plan-Tailored Plan
Amerihealth Caritas
North VA BCBS CareFirst
Rhode Island Medicaid RI
South Carolina Medicaid SC
MEDICAL nECESSITY
Medical necessity is a legal doctrine in the United States related to activities that may be justified as reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care.
Medicare pays for medical items and services that are "reasonable and necessary" or "appropriate" for a variety of purposes. By statute, Medicare may pay only for items and services that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member" unless there is another statutory authorization for payment.
Medicare has several policies that describe coverage criteria, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), formerly known as Local Medical Review Policies (LMRP).
Based on the criteria from these policies, Phase2 has incorporated medical necessity documents for each of our Molecular panels. To support this effort, we ask our providers to include all relevant ICD-10 codes, supporting medical notes, and patient history documents with each test order.
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