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If an preliminary dedication concerned a call regarding the medical necessity of an item or service, the QIC’s reconsideration must contain consideration by a panel of physicians or acceptable healthcare professionals, and should be based mostly on scientific expertise, the patient’s medical information, and medical, technical, and scientific proof on record. The place the declare entails physician services, the reviewing skilled must be a physician. Nevertheless, the physician reviewer need not be in the same specialty because the physician whose claims have been denied.

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