Medical Management. The benefits available to You under this Contract may be subject to pre-service, concurrent and retrospective reviews to determine when services should be covered by Us. The purpose of these reviews is to promote the delivery of cost-effective medical care by reviewing the use of procedures and, where appropriate, the setting or place the services are performed. Covered Services must be Medically Necessary for benefits to be provided.
Medical Management. The process of properly allocating healthcare resources through programs such as Utilization Management and Case Management.
Medical Management. PHS shall be solely responsible for all claims processing and auditing, health services (including hospital pre-certification, outpatient pre-certification, large claim case management and utilization review) and all risk accounting for the provider bonus arrangements under the HMO Plans.
Medical Management. The benefits available to You under this Policy may be subject to pre-service, concurrent and retrospective reviews to determine when services should be Covered by Us. The purpose of these reviews is to promote the delivery of cost-effective dental care by reviewing the use of procedures and, where appropriate, the setting or place the service are performed. Covered Services must be Medically Necessary for benefits to be provided.
Medical Management. (1) State Fund will utilize available medical networks to ensure maximum medical cost containment.
(2) State Fund will provide medical reports to a RTWC unless prohibited by State and/or Federal law or withheld with reason by State Fund. It is the Department's responsibility to maintain the confidentiality of all supplied reports.
(3) State Fund will ensure that there is a Medical Provider Network (MPN) available for Departments.
(4) Departments will utilize the MPN provided and refer injured workers to an MPN doctor unless the injured worker has a valid pre-designation form on file.
Medical Management. The Contractor shall identify any requested medical services related to motor vehicle accidents, or work related injuries, and refer these claims to the recoveries specialist for further investigation.
Medical Management. The MCO shall provide medical management services for all workers' compensation cases that result from injuries and occupational diseases to employees arising out of the course and scope of employment as provided by law, including Medical Case Management services as defined under Appendix G of this Agreement). The MCO recognizes that (1) all services provided are linked to the successful return to work or resolution for injured workers, (2) close interaction between the MCO and the employer is critical to the program's success, (3) close attention to treatment protocols and Treatment Plans is required, (4) provider networks must emphasize the appropriate provider composition to treat occupational injuries and illness, and (5) continually meeting data requirements is essential for effecting and measuring return to work.
Medical Management. 1. Describe how your company will meet the requirements outlined in 2.18 Medical Management.
Medical Management. 19 8.0 FINANCE.......................................... 20 9.0 SECURITY......................................... 21 10.0 UNDERWRITING..................................... 22 EXHIBIT A - DELIVERABLE TIME FRAMES.................... 22 EXHIBIT B - REPORT NAMES............................... 23 This Schedule is a summary description of the Standard Operating Services and the related System functionality available to Client under the Agreement. It is not a comprehensive or definitive statement of System functionality or capability. cimr reserves the right to modify the System as and when cimr deems appropriate. Client must provide certain information to cimr or complete certain other tasks (collectively, the "Deliverables") before many System functions can be implemented. Similarly, Client must provide certain Deliverables to cimr on an on-going basis in order for the System to reflect up-to-date information. Exhibit A lists some (but not all) important Deliverables, and the time by which cimr must receive the Deliverable to initially implement or on an on-going basis update - the System ("Time Frames").
Medical Management. 2.1 Provides advice on rural and regional specific medical related matters.
2.2 Provides regional medical management and oversight for all regional clinical services.
2.3 Ensures actions and initiatives arising from senior MPs and other committees internal and external to XXXXX are progressed.
2.4 Facilitates and promotes an efficient and effective Health Service through the provision of advice and support to regional executive/ managers.
2.5 Oversees the coordination of complex medico-legal cases within the region.
2.6 Seeks opportunities to facilitate medical education and research in the region.
2.7 Supports Disaster Management and Business Continuity Plans.
