Medical Policies are established to guide the actions of practitioners and administrators in health care organizations. In the clinical laboratory, policies are frequently distributed based on HCFA reimbursement guidelines. These guidelines typically require certain tests to have specific documentation of the medical necessity (ICD-9 codes) in order for reimbursement to occur.

The MetricomMPS Medical Policy Server is a server designed to interact with other application programs such as MetricomLRS Laboratory Requisitioning/Reporting System. During the requisitioning process, the tests and corresponding diagnoses are recorded during completion of the requisition, and a request is made to the Medical Policy Server.

The Medical Policy Server contains a list of rules that can be easily defined and maintained in the MPS database using simple, English-language statements. The policies are defined as a set of conditions that identify specific data elements (such as a specific test or diagnosis code ), conditional operators (such as equal, or in range), and data values (such as 'Glucose' or '251.0'). Several conditions may be connected with combinations of And/Or logic, and multiple levels of nested grouping may be defined, allowing the user to describe very complex medical policies in a single rule.

Severity levels for each policy can be set to control user input at the remote application by issuing warnings, requesting additional data, or preventing input altogether.

Once a policy is created, the user can immediately test it within the Server without requiring the client application. There is no limit to the number of policies that can be saved.

If a policy is violated, a warning is automatically sent to the remote application to alert the user to any potential conflicts, or to prevent input. The 'Details' dialog can be used to inform the user of what action to take or to offer more description of the Medical Policy.

The remote client application automatically receives basic policy information for all policies that apply to the submitted information thus offering the user the opportunity to respond to any warning at the time tests are ordered; possibly while the patient is still present.