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
Benefit Determination (NOABD), as outlined in California Code of 21 Regulations Title 9 Chapter 11 Section 1850.210 and Title 22, Section 50179 means to provide formal 22 written notification via hand-delivery or mail to Medi-Cal Members and faxed or mailed to the 23 ADMINISTRATOR when services are denied, modified, reduced, delayed, suspended or terminated as 24 specified by State standards.
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.