Continued Stay Reviews Sample Clauses

Continued Stay Reviews. The Contractor shall have the capability and established procedures to receive Continued Stay Reviews requests for additional inpatient days of care for admissions previously certified and conduct prior authorizations on or before the next review point (i.e. the last certified day). The Contractor shall ensure determinations for Continued Stay Reviews are completed ninety-eight percent (98%) of the time within twenty- four (24) hours (one workday) of receipt when Members remain hospitalized and within twenty-four (24) hours (one workday) when Members have been discharged.
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Continued Stay Reviews. Any involuntarily admitted individual will be reviewed by DMH Utilization Review Care Manager. Continued Stay Review periodicity will be determined by the DMH Utilization Review Care Manager. Designated Hospital’s(DH) will provide clinical information requested by the care manager in order to authorize the period of inpatient care during the period of time under review. Any continued stay review that appears to no longer meet inpatient or Level I patient clinical eligibility criteria will be referred to the DMH Care Manager assigned to the DH for concurrent review. Only after consultation between the DMH Care Manager and review between the DMH Utilization Review Care Manager with the DH utilization review representative, a continued stay determination will be made. The DMH Utilization Review Care Manager in consultation with the DMH Medical Director or Psychiatrist designee will:  certify the continued stay as Level I involuntary  certify the continued stay as acute, voluntary or involuntary, and identify the continued stay review periodicity; or  certify the continued stay as “awaiting discharge” level of care and the basis for the determination; or  certify no inpatient level of care being met and issue payment denial. For DMH tracking purposes with Level I inpatient providers, and evaluation of Level I inpatient bed utilization for annual real, actual cost reconciliation, the afore mentioned certifications for Continued Stay Reviews will:  Authorize Level I clinical eligibility criteria as being met and identify subsequent continued stay review date. Continuing Level I enhanced payment clinical eligibility criteria will consider intensity and duration of treatment services and routine documentation of:  The need for continued allocation of significant and more than usual resources to maintain the safety of the patient, other patients, or staff;  intractable mental illness symptomology, ongoing behavioral dysregulation and instability with demonstrated treatment plan modifications;  complex medication management that must occur in an acute inpatient setting;  active daily restorative interventions/services not available in alternate level of care settings. This authorization level maintains enhanced payment for inpatient billing and coding purposes; or  Authorize “acute” level of care (Level I patient remains acute, no longer requires additional level I resources, and internal transfer to other units is possible*) and effective date. This autho...
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Related to Continued Stay Reviews

  • 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.

  • Annual Reviews The Recipient shall:

  • 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:

  • BUSINESS REVIEWS Supplier must perform a minimum of one business review with Sourcewell per contract year. The business review will cover sales to Participating Entities, pricing and contract terms, administrative fees, sales data reports, performance issues, supply issues, customer issues, and any other necessary information.

  • Procurement Related Complaints and Administrative Review 49.1 The procedures for making a Procurement-related Complaint are as specified in the TDS.

  • Medical Review Officer The Medical Review Officer (MRO) shall be a licensed physician who has a knowledge of substance abuse disorders and has appropriate medical training to interpret and evaluate an individual’s positive test result together with the employee’s medical history and any other relevant biomedical information.

  • Annual Physical Examination A permanent employee shall be granted up to one day per year with pay for the purpose of a comprehensive physical examination provided that the verification of such an examination is submitted to the District.

  • Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time.

  • Compliance Reviews The Department may conduct a compliance review of the Contractor’s security procedures before and during the Contract term to protect Confidential Information.

  • Performance Reviews The Employee will be provided with a written performance appraisal at least once per year and said appraisal will be reviewed at which time all aspects of the assessment can be fully discussed.

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