Medical Necessity Exclusion Maintenance

Through the medical necessity exclusion pages, you can override ClaimStaker medical necessity edits. Code combinations entered here will not appear on your Claims in Error reports. ClaimStaker has two medical necessity exclusion maintenance pages: one for professional exclusions and one for institutional exclusions.

We recommend you do not populate the user exclusion tables until after you have been scrubbing submission files for some time and are familiar with the process. You may find there are medical necessity edits appearing on the Claims in Error report that you do not wish to see on future reports.

Medical necessity exclusion entries may be created to apply to all payers (commercial or otherwise) or created for any single payer listed on the working payer list.

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