Medical Coverage Policy Evaluations

Medical Coverage Policy Evaluations:

The Medical Coverage Policy Evaluation (MCPE) is an invaluable tool for health plans and managed care organizations. During policy development or update, IMEDECS conducts a thorough review of coverage criteria/policy used to approve or deny healthcare services. Physicians with expertise in providing the treatment at issue evaluate the policy against scientific literature and current practice guidelines to provide recommendations of additional indications, limitations or exclusions to the policy.

IMEDECS' MCPEs provide you with access to:

Best Practices - Current clinical practice guidelines developed by relevant professional societies; government organizations, health care organizations or medical specialty organizations are considered and referenced as part of the reviewers' evaluations.

Best Evidence - The expert reviewers research late-phase clinical trials or well-designed studies to gather the best evidence regarding the diagnosis or treatment at issue.

Best Solutions - Reports include answers to client questions such as:

Do you believe the policy to be accurate as written?
Do you believe the conditions listed as criteria for coverage to be complete?
Are there any FDA approved uses missing? If so, describe the diagnosis and suggest what the community standard is for treatment.
Where does the procedure fall in the hierarchy of available treatment options?

To see a sample MCPE report, click here.