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If an preliminary determination concerned a choice regarding the medical necessity of an item or service, the QIC’s reconsideration must contain consideration by a panel of physicians or appropriate healthcare professionals, and should be based on medical experience, the affected person’s medical information, and medical, technical, and scientific proof on document. The place the declare involves physician companies, the reviewing skilled have to be a doctor. Nonetheless, the physician reviewer needn’t be in the same specialty because the physician whose claims have been denied. Related Post: total stranger
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