Medical Necessity Reminders

Medical necessity is a fundamental requirement for reimbursement and plays a key role in preventing fraud, waste, and abuse. Services billed to Meridian must be clinically appropriate, supported by the patient's condition, and documented in the medical record.

Key Reminders for Providers

• Ensure documentation clearly supports the medical necessity of all services, procedures, tests, and supplies billed.
• Select diagnosis and procedure codes that accurately reflect the patient's condition and treatment provided.
• Avoid billing for services that are not supported by the medical record or exceed what is clinically necessary.
• Maintain complete and legible documentation, including orders, treatment plans, progress notes, and test results when applicable.

If you need to report suspected fraud, waste, and/or abuse, email Meridian Compliance, email Meridian Special Investigations Unit, or call the MDHHS Office of Inspector General.