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:
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.
b) Additional reviews shall be conducted as needed or upon request from CONTRACTOR’s Medical Director, and urgent reviews may be conducted when circumstances warrant. Lengthy stays may require consultations with CONTRACTOR’s Medical Director.
c) All concurrent reviews, or peer-to-peer reviews shall be documented in CONTRACTOR care management system.
Concurrent Reviews. A. 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 one (1) business day of the end of the 45-day time period.
Concurrent Reviews. 25 a) Inpatient acute psychiatric level of care reviews shall be conducted telephonically, 26 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.
27 b) Additional reviews shall be conducted as needed or upon request from 1 CONTRACTOR’s Medical Director, and urgent reviews may be conducted when circumstances warrant.
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...
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.
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.
Concurrent Reviews
