Medical Necessity Determination. 2.6.3.1 The CONTRACTOR may establish procedures for the determination of medical necessity. The determination of medical necessity shall be made on a case by case basis and in accordance with the definition of medical necessity defined in TCA 71- 5-144 and TennCare rules and regulations. However, this requirement shall not limit the CONTRACTOR’s ability to use medically appropriate cost effective alternative services in accordance with Section 2.6.5.
Appears in 3 contracts
Samples: Contractor Risk Agreement, An Agreement, Contractor Risk Agreement
Medical Necessity Determination. 2.6.3.1 The CONTRACTOR may establish procedures for the determination of medical necessity. The determination of medical necessity shall be made on a case by case basis and in accordance with the definition of medical necessity defined in TCA 71- 5-144 and TennCare rules and regulations. However, this requirement shall not limit the CONTRACTOR’s ability to use medically appropriate cost effective alternative services alternatives in accordance with Section 2.6.5.
Appears in 2 contracts
Samples: Contractor Risk Agreement (Amerigroup Corp), Contractor Risk Agreement
Medical Necessity Determination. 2.6.3.1 The CONTRACTOR may establish procedures for the determination of medical necessity. The determination of medical necessity shall be made on a case by case basis and in accordance with the definition of medical necessity defined in TCA 71- 5-144 and TennCare rules and regulations. However, this requirement shall not limit the CONTRACTOR’s ability to use medically appropriate cost effective alternative services in accordance with Section 2.6.5A.2.6.5.
Appears in 2 contracts
Samples: clpc.ucsf.edu, clpc.ucsf.edu
Medical Necessity Determination. 2.6.3.1 The CONTRACTOR may establish procedures for the determination of medical necessity. The determination of medical necessity shall be made on a case by case basis and in accordance with the definition of medical necessity defined in TCA 71- 71-5-144 and TennCare rules and regulations. However, this requirement shall not limit the CONTRACTOR’s ability to use medically appropriate cost effective alternative services in accordance with Section 2.6.5.
Appears in 1 contract
Samples: Contractor Risk Agreement
Medical Necessity Determination. 2.6.3.1 The CONTRACTOR may establish procedures for the determination of medical necessity. The determination of medical necessity shall be made on a case by case basis and in accordance with the definition of medical necessity defined in TCA 71- 71-5-144 and TennCare rules and regulations. However, this requirement shall not limit the CONTRACTOR’s ability to use medically appropriate cost effective alternative services alternatives in accordance with Section 2.6.5.
Appears in 1 contract
