Post-service decisions are determinations of medical necessity and/or appropriate level of care when the care has already been received, for example, retrospective review.
Notification of post-service decision denial determinations are given electronically or in writing to the practitioner and customer within 30 calendar days of the request.
All potential post-service denial decisions based on medical necessity or appropriate level of care are reviewed by the Medical Director and a determination made by him, or his designee.