Medical Necessity Review

Medical Necessity Reviews evaluate whether a treatment, procedure, diagnostic test, medication, service, or level of care is clinically appropriate, medically necessary, and consistent with evidence-based guidelines, accepted standards of practice, and payer coverage criteria.

QPS provides independent, specialty-matched reviews performed by actively practicing, board-certified physicians and allied health professionals. Our reviewers assess the clinical documentation, diagnosis, treatment plan, severity of illness, intensity of service, and applicable evidence-based guidelines.

Each review includes a thorough clinical analysis, supporting rationale, and references to applicable guidelines and standards.