Administrative Hearings

Clinical support for Medicaid fair hearings

When a behavioral health denial reaches a Medicaid fair hearing, the outcome turns on whether the record supports the level of care in dispute. Both sides need the same thing the rest of this work provides: an independent physician who can read the chart, state what it carries, and explain it clearly to a hearing officer who is not a clinician.

I provide expert neuropsychiatric review and testimony for fair hearings, for payers defending a determination and for psychiatric providers contesting one. The role is clinical, not legal. I analyze the documentation, render an opinion on medical necessity and level of care, and present that reasoning in a form a hearing officer can follow and rely on.

What the support includes

Independent review of the disputed admission or service against the documentation available for each day of care
A written opinion on medical necessity and appropriate level of care, with the reasoning stated plainly
Expert testimony at the hearing, explaining the clinical picture and the basis for the determination
A clear statement of what the record supports, what is inferred, and what remains undetermined

Medical necessity is assessed day by day, not as a single judgment applied to an entire course of care. The opinion does not change with the party that retains it. A payer and a provider would each receive the same analysis applied the same way, because an opinion that bends to its audience is one a hearing officer learns to discount. The work supports a decision. It does not argue for one.