Managed Care Process. The Medical Director and/or SHL's Utilization Review Committee will review proposed services and supplies to be received by an Insured to determine: If the services are Medically Necessary and/or appropriate. The appropriateness of the proposed setting. The required duration of treatment or admission.
Appears in 2 contracts
Samples: Epo Agreement of Coverage, Epo Agreement of Coverage
Managed Care Process. The Medical Director and/or SHL's Utilization Review Committee will review proposed services and supplies to be received by an Insured to determine: • If the services are Medically Necessary and/or appropriate. • The appropriateness of the proposed setting. • The required duration of treatment or admission. Following review, SHL will complete the Prior Authorization written notification and send a copy to the Provider and the Insured. The Prior Authorization form will specify approved Covered Services and supplies. Prior Authorization is not a guarantee of payment for Covered Services.
Appears in 1 contract
Managed Care Process. The Medical Director and/or SHL's Utilization Review Committee will review proposed services and supplies to be received by an Insured to determine: • If the services are Medically Necessary and/or appropriate. • The appropriateness of the proposed setting. • The required duration of treatment or admission.
Appears in 1 contract
Samples: Agreement of Coverage
