Common use of Prospective Procedure Review Clause in Contracts

Prospective Procedure Review. Benefits will be paid under either the In-Network or Out-of-Network provisions of Section II and Section V for covered charges only if properly certified by the Utilization Review Agent. Such charges must be for services rendered to a Participant eligible for benefits under the Plan and such services must be covered charges described herein for the type of coverage (In-Network or Out-of-Network) when applicable. This program works in conjunction with the Pre-Admission Certification program and does not replace it. The inpatient and outpatient surgical, diagnostic and therapeutic procedures included in this program are as follows (the "Schedule of Prospective Procedure Review"):

Prospective Procedure Review. Benefits will be paid under either the In-Network or Out-of-of- Network provisions of Section II and Section V for covered charges only if properly certified by the Utilization Review Agent. Such charges must be for services rendered to a Participant eligible for benefits under the Plan and such services must be covered charges described herein for the type of coverage (In-Network or Out-of-Network) when applicable. This program works in conjunction with the Pre-Admission Certification program and does not replace it. The inpatient and outpatient surgical, diagnostic and therapeutic procedures included in this program are as follows (the "Schedule of Prospective Procedure Review"):

Prospective Procedure Review. Benefits will be paid under either the In-Network or Out-of-Network provisions schedule of Section II and Section V for covered charges only if properly certified by the Utilization Review Agent. Such charges must be for services rendered to a Participant eligible for benefits under the Plan and such services must be covered charges described herein for the type of coverage (In-Network or Out-of-Network) when applicable. This program works in conjunction with the Pre-Admission Certification program and does not replace it. The inpatient and outpatient surgical, diagnostic and therapeutic procedures included in this program are as follows (the "Schedule of Prospective Procedure Review"):