Generated Narrative: CodeSystem medical-management-type Last updated: 2025-05-26 00:00:00+0000 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'.
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.
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Review of medical necessity while the patient is actively receiving treatment.
Review of medical necessity prior to receiving treatment.
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'.