Benefit determination means a decision of the enrollee's entitlement to payment for

Benefit determination means a decision to approve or deny a request to provide or make payment for a health care service or treatment.

Benefit determination means a determination by the Plan Administrator on a claim for benefits under the Plan, whether or not an Adverse Benefit Determination.

Examples of Benefit determination in a sentence

It shall be the duty of the director to administer Iowa Code chapter 96.24.1(38) Determination.a. Benefit determination.
If the Claim Administrator fails to timely provide the documents and information, the assigned IRO may terminate the external review and make a decision to reverse the Adverse Benefit determination or Final Internal Adverse Benefit Determination.
Joint Custody: If the specific terms of a court decree state that the parents will share joint custody, without stating that one of the parents is responsible for the health care expenses of the child, the plans covering the child will follow the order of Benefit determination rules outlined in Section C.
Joint Custody: If the specific terms of a court decree state that the parents will share joint custody, without stating that one of the parents is responsible for the health care expenses of the child, the plans covering the child will follow the order of Benefit determination rules outlined in Section C(2)(b).
This Section is intended to describe the order of Benefit determination rules govern the order in which each Plan will pay a claim for Benefits.

More Definitions of Benefit determination

Benefit determination means a decision to approve or deny a request to provide or

Benefit determination means a decision by an MCO about a request for services (also referred to as “prior authorizations” or “medical necessity reviews”).

Benefit determination means a decision of the enrollee's entitlement to payment for covered health care services as defined in an agreement with the payor or its delegate.

Benefit determination means a notification, in writing, approved by the Tribal Health Services Professionals, issued by the Program Administrator to the applicant (or his or her Financial Conservator or Power of Attorney), that indicates a finding of approval or denial of his or her application for Disability Benefits and/or addresses a Participant’s Continued Qualification for the Program, wherein Disability Benefit may be continued, suspended or terminated.

Benefit determination means any of the following:

Benefit determination has the meaning ascribed in Subsection 1.1(a);

Benefit determination means the Claims Administrator’s decision with respect to a Claim or an Appeal.