Common use of Medically Necessary Clause in Contracts

Medically Necessary. Shall be defined by Tennessee Code Annotated, Section 71-5-144, and shall describe a medical item or service that meets the criteria set forth in that statute. The term “medically necessary”, as defined by Tennessee Code Annotated, Section 71-5- 144, applies to TennCare enrollees. Implementation of the term “medically necessary” is provided for in regulations at 1200-13-16, consistent with the statutory provisions, which control in case of ambiguity. No enrollee shall be entitled to receive and TennCare shall not be required to pay for any items or services that fail fully to satisfy all criteria of “medically necessary” items or services, as defined either in the statute or in regulations at 1200-13-16.

Medically Necessary. Shall be defined by Tennessee Code Annotated, Section 71-71- 5-144, and shall describe a medical item or service that meets the criteria set forth in that statute. The term “medically necessary”, as defined by Tennessee Code Annotated, Section 71-5- 5-144, applies to TennCare enrollees. Implementation of the term “medically necessary” is provided for in regulations at 1200-13-16, consistent with the statutory provisions, which control in case of ambiguity. No enrollee shall be entitled to receive and TennCare shall not be required to pay for any items or services that fail fully to satisfy all criteria of “medically necessary” items or services, as defined either in the statute or in regulations at 1200-13-16.

Medically Necessary. Shall be defined Defined by Tennessee Code Annotated, Section 71-5-144, and shall describe a medical item or service that meets the criteria set forth in that statute. The term “medically necessary”, “ as defined by Tennessee Code Annotated, TCA Section 71-5- 144, 5-144 applies to TennCare enrollees. Implementation of the term “medically necessary” is provided for in regulations at 1200-13-16these rules, consistent with the statutory provisions, which control in case of ambiguity. No enrollee shall be entitled to receive and TennCare and/or CoverKids shall not be required to pay for any items or services that fail fully to satisfy all criteria of “medically necessary” items or services, as defined either in the statute or in regulations at the Medical Necessity rule chapter 1200-13-16.