Medical Case Management. This program allows a consultant to review a patient's medical treatment plan to determine whether the covered person qualifies for alternate medical care. The determination of eligibility for a patient's medical case management will be primarily based upon medical necessity and appropriate medical care. Recommendations will be made to the family and health care providers; however, the decision to receive alternate medical care rests with the employee and the physician. The Medical Utilization Review Administrator will recommend alternate medical treatment on a case-by-case basis. Alternate medical treatment benefits refer to expenses that are approved before they are incurred, which may not otherwise be payable as covered expenses under the medical plan.
Medical Case Management. A program that allows a consultant to review the medical treatment for an individual to determine whether the covered person does or does not qualify for alternate medical treatment benefits. The determination for a patient's medical case management eligibility will be primarily based upon medical necessity and appropriate medical care. The Plan Administrator will recommend alternate medical treatment on a case-by-case basis. Alternate medical treatment benefits refer to expenses that are approved before they are incurred, which may not otherwise be payable as covered expenses under the medical plan.
Medical Case Management. The Town or its designated occupational health consultant will review all requests for indemnification of medical expenses and will make a determination of reimbursement of payment for indemnification of medical expenses and will make payment for reasonable and customary charges per the IOD policy.
Medical Case Management. 1.7.1 Contractor shall refer for medical case management all claims which meet agreed upon medical criteria. The criteria for case referrals shall be incorporated in the Client Service Instructions as amended from time to time during the life of this agreement, which is attached and incorporated by reference as if fully set forth herein.
Medical Case Management. Contractor shall use XStremeMD for medical case management following an occupational injury or illness event. Note: Contractor may elect to use its own case management provider if pre-approved by Company.
Medical Case Management. The Town or its designated occupational health consultant will review all requests for indemnification of medical expenses and will make payment for reasonable charges. Injured employees will be required to provide medical information release forms from all relevant medical providers for injuries/illnesses for which benefits are sought. It is understood that all employee medical information will be kept strictly confidential as provided by law. Nothing herein, however, shall prevent the Town Manager or the Chief from having a firefighter on approved IOD status subsequently reexamined by a medical provider of the Town’s choosing at reasonable intervals, normally not less than fourteen (14) calendar days, to see if the firefighter has sufficiently recovered to commence duty. The Town will incur the cost of the Town appointed medical provider. As stipulated in Section 3 of this article, if there is disagreement between the firefighter’s physician and the medical provider chosen by the Town regarding treatment, recovery and/or the ability to return to work, a third physician designated by the two conferring doctors will be assigned to conduct an examination within fourteen (14) calendar days after the two doctors confer. A firefighter shall not be required to return to work during such third physician process. The third physician shall render his/her decision within seven
Medical Case Management f. On-site Medical Management, Medical Bill Repricing and Vocational Rehabilitation.
