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Meeting ‘Milliman Criteria’ Requirements by Doug Smith M.D.

Spine Imaging: 5 Strategies for Meeting ‘Milliman Criteria’ Requirements:

Written by By Douglas Smith, MD, Founder of Musculoskeletal Imaging Consultants | April 12, 2013

The Milliman accounting firm has proposed a series of clinical and imaging criteria to satisfy and document as best practice before a surgical procedure is performed. Many insurance companies have adopted the Milliman criteria as absolute requirements before approving surgical fusions and other procedures and will reject pre-authorization unless each of the Milliman criteria are specifically documented in the medical records submitted in the pre-authorization packet. Ideally, the entire pre-operative evaluation process would be designed to document the Milliman criteria. Technology and terminology best practices must be adopted and all members of the preoperative planning team must be sensitive to the importance of documenting how the Milliman criteria are satisfied in each patient’s medical record. Here are some components of Milliman sensitive pre-operative evaluation process. Read the full article here courtesy of Beckers Spine Review.



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