Letter of Medical Necessity
Skill packages tagged with “Letter of Medical Necessity”
Letter of medical necessity builder
Draft a structured letter of medical necessity (LOMN) from a normalized case record and chart excerpts, using the Genentech/Novartis field model: patient identifiers, diagnosis and ICD-10, severity, prior therapies with outcomes, clinical rationale, treatment plan and dosing, supporting guidelines, and enclosure manifest. Enforces completeness, ICD-10 specificity, prior-therapy history structure, and disease-score capture before handing the draft to the clinical-claim-evidence-mapper for citation and export gating.
LOMN overlay — musculoskeletal / spine / pain
Specialty overlay for letter-of-medical-necessity-builder that applies stricter MSK, spine, orthopedic, and pain-management validations: conservative-care step-therapy rules per procedure (spine surgery, neurostimulator, RFA, ESI, facet injection, DME), ODI/NDI/VAS-pain trend analysis across baseline and post-conservative-care follow-up, and imaging-to-symptom concordance checks. Invoked from within the core LOMN workflow when the case specialty is MSK; adds requirements, does not weaken the core.