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"): 1. Magnetic Resonance Imaging (MRI) 2. Computerized Axial Tomography (CAT) scans (a) Non-Emergency Certification. Non-emergency inpatient and outpatient surgical, diagnostic and therapeutic procedures described in the Schedule of Prospective Procedure Review will require certification as to the need and appropriate setting of the procedure.

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"): 1. Magnetic Resonance Imaging (MRI) 2. Computerized Axial Tomography (CAT) scans (a) Non-Emergency Certification. Non-emergency inpatient and outpatient surgical, diagnostic and therapeutic procedures described in the Schedule of Prospective Procedure Review will require certification as to the need and appropriate setting of the procedure.

Prospective Procedure Review. Benefits will be paid under either the In-Network or Out-of- 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"): 1. Magnetic Resonance Imaging (MRI) 2. Computerized Axial Tomography (CAT) scans (a) Non-Emergency Certification. Non-emergency inpatient and outpatient surgical, diagnostic and therapeutic procedures described in the Schedule of Prospective Procedure Review will require certification as to the need and appropriate setting of the procedure.