Who determines medical neccesity for services on the referral Requirement List?

For covered services, we will rely on the ordering physician to use evidence based guidelines to determine medical appropriateness of care and compliance with benefit  guidelines when treating members. To assist you with determination, you will continue to have access to HAP’s Benefit Administration Manual (BAM) available at www.hap.org. If you determine that the service is not medically necessary you are responsible for advising the member of this decision.


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