Common use of Medical Necessity Assistance Clause in Contracts

Medical Necessity Assistance. In all cases where the Group and/or a Group Provider has made a determination regarding the Medical Necessity of a medical service requested or provided to a Member, Group shall, upon the request of Blue Shield, assist Blue Shield in determining the Medical Necessity of such service and provide relevant medical records to Blue Shield and participate in any grievance, arbitration, and/or other proceedings in which such Medical Necessity determination is an issue. Moreover, Group agrees to cooperate with and abide by the Medical Necessity determination of any external review entity to which Blue Shield is either obligated by law to submit such disputes or for which Blue Shield has implemented a program to submit such disputes to external review.