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Generated Narrative: CodeSystem medical-management-type

Last updated: 2025-05-26 00:00:00+0000; Language: en

Profile: Shareable CodeSystem

This case-sensitive code system http://terminology.hl7.org/CodeSystem/medical-management-type defines the following codes:

Code | Display | Definition
concurrent-review | Concurrent Review | Review of medical necessity while the patient is actively receiving treatment.
prior-auth | Prior Authorization | Review of medical necessity prior to receiving treatment.
step-therapy | Step Therapy (Fail First) | Requirement that lower cost or preferred treatments be tried, or perhaps contra-indicated, before alternatives are utilized. This policy is sometimes referred to as 'fail first'.

# description
Types of medical management requirements or processes used by health insurers (payers) that may impact whether a service or item is covered or reimbursement rates.

# copyright
This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license

# concept[].definition
Review of medical necessity while the patient is actively receiving treatment.

# concept[].definition
Review of medical necessity prior to receiving treatment.

# concept[].definition
Requirement that lower cost or preferred treatments be tried, or perhaps contra-indicated, before alternatives are utilized. This policy is sometimes referred to as 'fail first'.