Concurrent Reviews Sample Clauses

Concurrent Reviews a) Inpatient acute psychiatric level of care reviews shall be conducted telephonically, or as required per MHP-DHCS Agreement requirements and as defined by CCR Title 9 section 1810.100 and 1810.110, at intervals appropriate to the intensity of care.
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Concurrent Reviews. When you make a request for additional treatment, when we had previously approved a course of treatment that is about to end, the Health Plan will make concurrent review determinations within one (1) working day of receiving the request or within one working day of obtaining all the necessary information so long as the request for authorization of additional services is made prior to the end of prior authorized services. In the event that the our review results in the end or limitation of Health Care Services, we will make a review determination with sufficient advance notice so that you can file a timely Grievance or Appeal of our decision. If you have an Urgent Medical Condition, then a request for concurrent review will be handled like any other pre-service request for review when an Urgent Medical Condition is involved, except that our decision will be made within one (1) working day. If the Health Plan authorizes an extended stay or additional Health Care Services under the concurrent review, the Health Plan will:
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Concurrent Reviews. 1. Utilization review decisions for services during the course of care (concurrent reviews) will be made, and notice provided to You (or Your designee) [and Your Provider], by telephone and in writing, within one (1) business day of receipt of all necessary information. If We need additional information, We will request it within one (1) business day. You or Your Provider will then have 45 calendar days to submit the information. We will make a determination and provide notice to You (or Your designee) and Your Provider, by telephone and in writing, within one (1) business day of Our receipt of the information or, if We do not receive the information, within 15 calendar days of the end of the 45-day time period.
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Concurrent Reviews. A utilization review conducted during a patient stay at a healthcare facility or during treatment of the patient at the office of a healthcare professional or other place where healthcare services are offered to inpatients or outpatients. Copayment Fixed amount of money that the insured under this certificate pays to the provider to receive certain services. Consensual Couples Couples formed by a man and a woman who sustain a stable couple relationship and live under the same household without being legally married. To the effects of this certificate of benefits, the following documentation is required as proof: Sworn statement certifying the relationship of the couple and that they have been living together for at least one (1) year; Sworn statement certifying that neither are legally married to someone else; Authorization from the employer for the inclusion of the partner; The benefit will be authorized to eligible active employees (depends on each group); In case of separation, a sworn statement will be requested certifying the separation and, subsequently the other person will be withdrawn from the plan. Consensual Couples of the Same Sex Couples formed by two individuals of the same sex, who live under the same household as a stable couple. To the effects of this certificate of benefits, the following documentation is required as proof: Sworn statement certifying the relationship of the couple and that they have been living together for at least one (1) year; Sworn statement certifying that neither are legally married to someone else; Authorization from the employer for the inclusion of the partner; The benefit will be authorized to eligible active employees (depends on each group); In case of separation, a sworn statement will be requested certifying the separation and, subsequently the other person will be withdrawn from the plan. Convalescent Home Home where various health services are provided designed to help people recuperate after a serious illness, surgery or injury. The services can consist of medical, nursing, skilled care or therapy. They can be provided in different settings, including, rehabilitation hospitals, outpatient treatment centers, skilled Covered Services Assessments, procedures and treatments offered and delivered by a provider to the insured, subject to the specifications included in his or her coverage, and clauses and conditions under this certificate. Cosmetic Procedures (Aesthetic surgery) Any procedure or medication solel...
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Concurrent Reviews. In order to determine continuing Medical Necessity for an Enrollee’s treatment, concurrent reviews of Enrollee’s treatment will occur on a regular basis. During each review, a HPCC clinician monitors the Enrollee’s course of treatment to determine its effectiveness, the appropriate level of care, and continued Medical Necessity. The HPCC clinician must authorize all extended lengths of stay and transfers to different levels of care as well as any related additional services.
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Concurrent Reviews. In order to determine continuing Medical Necessity for an enrollee's treatment, concurrent reviews of enrollee's treatment will occur on a regular basis. During each review, a Xxxxxx Health Care Advisor monitors the enrollee's course of treatment to dete1mine its effectiveness, the appropriate level of care, and continued Medical Necessity. The Xxxxxx Health Care Advisor must authorize all extended lengths of stay and transfers to different levels of care as well as any related additional services. Xxxxxx'x Process and Criteria for determining Medical Necessity will be furnished to the enrollee upon request.
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Concurrent Reviews 
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Related to Concurrent Reviews

  • Independent Review Contractor shall provide the Secretary of ADS/CIO an independent expert review of any Agency recommendation for any information technology activity when its total cost is $1,000,000.00 or greater or when CIO requires one. The State has identified two sub-categories for Independent Reviews, Standard and Complex. The State will identify in the SOW RFP the sub-category they are seeking. State shall not consider bids greater than the maximum value indicated below for this category. Standard Independent Review $25,000 Maximum Complex Independent Review $50,000 Maximum Per Vermont statute 3 V.S.A. 2222, The Secretary of Administration shall obtain independent expert review of any recommendation for any information technology initiated after July 1, 1996, as information technology activity is defined by subdivision (a) (10), when its total cost is $1,000,000 or greater or when required by the State Chief Information Officer. Documentation of this independent review shall be included when plans are submitted for review pursuant to subdivisions (a)(9) and (10) of this section. The independent review shall include: • An acquisition cost assessment • A technology architecture review • An implementation plan assessment • A cost analysis and model for benefit analysis • A procurement negotiation advisory services contract • An impact analysis on net operating costs for the agency carrying out the activity In addition, from time to time special reviews of the advisability and feasibility of certain types of IT strategies may be required. Following are Requirements and Capabilities for this Service: • Identify acquisition and lifecycle costs; • Assess wide area network (WAN) and/or local area network (LAN) impact; • Assess risks and/or review technical risk assessments of an IT project including security, data classification(s), subsystem designs, architectures, and computer systems in terms of their impact on costs, benefits, schedule and technical performance; • Assess, evaluate and critically review implementation plans, e.g.: • Adequacy of support for conversion and implementation activities • Adequacy of department and partner staff to provide Project Management • Adequacy of planned testing procedures • Acceptance/readiness of staff • Schedule soundness • Adequacy of training pre and post project • Assess proposed technical architecture to validate conformance to the State’s “strategic direction.” • Insure system use toolsets and strategies are consistent with State Chief Information Officer (CIO) policies, including security and digital records management; • Assess the architecture of the proposed hardware and software with regard to security and systems integration with other applications within the Department, and within the Agency, and existing or planned Enterprise Applications; • Perform cost and schedule risk assessments to support various alternatives to meet mission need, recommend alternative courses of action when one or more interdependent segment(s) or phase(s) experience a delay, and recommend opportunities for new technology insertions; • Assess the architecture of the proposed hardware and software with regard to the state of the art in this technology. • Assess a project’s backup/recovery strategy and the project’s disaster recovery plans for adequacy and conformance to State policy. • Evaluate the ability of a proposed solution to meet the needs for which the solution has been proposed, define the ability of the operational and user staff to integrate this solution into their work.

  • Agreement Review If, pursuant to section 25.10 (Review of Agreement) of the Bilateral Agreement, the Bilateral Agreement is reviewed after three or five years, or both, of the effective date of the Bilateral Agreement, and any changes to the Bilateral Agreement are required as a result, the Parties agree to amend the Agreement as necessary and in a manner that is consistent with such changes.

  • Joint Review JADRC may, at the request of either party, review issues arising from the application of this Article.

  • Project Review A. Programmatic Allowances

  • Post Review With respect to each contract not governed by paragraph 2 of this Part, the procedures set forth in paragraph 4 of Appendix 1 to the Guidelines shall apply.

  • Reviews (a) During the term of this Agreement and for 7 years after the term of this Agreement, the HSP agrees that the LHIN or its authorized representatives may conduct a Review of the HSP to confirm the HSP’s fulfillment of its obligations under this Agreement. For these purposes the LHIN or its authorized representatives may, upon 24 hours’ Notice to the HSP and during normal business hours enter the HSP’s premises to:

  • Log Reviews All systems processing and/or storing PHI COUNTY discloses to 11 CONTRACTOR or CONTRACTOR creates, receives, maintains, or transmits on behalf of COUNTY 12 must have a routine procedure in place to review system logs for unauthorized access.

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