RAMQ criteria vs. notes
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The Advisory on Provincial Formulary Statements distinguishes 'reimbursement criteria' from 'definitions and notes'. Per the RAMQ Advisory, coverage claims must be accompanied by 'reimbursement criteria'. Can you please confirm if the 'definitions and notes' portion of the RAMQ listings are required to appear in APS? These usually deal with initial authorizations and continuing requests, and are not technically criteria.
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Hey @ALee
The same approach of “where applicable” should be applied to the RAMQ coverage as well. The intent of the inclusion is to ensure that the user is clear about the criteria for coverage as outlined by RAMQ. If the definitions and notes clarify or set the limitations/context for interpretation, they should be included.
