Retrospective Review. A review that is conducted after services are provided to a Member.
Retrospective Review. Within thirty (30) calendar days in accordance with Health and Safety Code Section 1367.01, or any future amendments thereto.
Retrospective Review. The INSURER will establish a Retrospective review Program that will address quality and utilization problems that may arise, as described in the INSURER's Proposal. The INSURER shall notify the ADMINISTRATION on a quarterly basis of all findings in the Retrospective Review Program. The ADMINISTRATION may review and/or audit the program findings at any time.
Retrospective Review. The INSURER will establish a program to determine medical necessity and service adequacy after the service has been rendered or paid to providers or physicians.
Retrospective Review. When a FCOI is not identified or managed in a timely manner or when an Investigator fails to comply with a management plan, the DIO, within 120 days of a determination of non- compliance, must complete a retrospective review of the Investigator’s activities and the PHS Award to determine if there was bias in the design, conduct, or reporting of such research. The information that must be documented in the retrospective review is outlined in Appendix C. If bias is found through a retrospective review, the DIO will notify the PHS Awarding Component promptly and submit a mitigation report containing the information outlined in Appendix D. Thereafter, the DIO will submit FCOI reports annually as described in Appendix A.
Retrospective Review. For projects that have not yet proceeded to construction, site-specific cultural resource investigations, surveys and reports used to support the Section 106 review process that are five or more years old, will be re-evaluated by WSDOT. The re-evaluation will include tribal consultation. The purpose of this re-evaluation is to establish whether, with the benefit of additional information gathered in the undertaking or otherwise over the passage of time, such materials accurately and correctly characterize the sites under review. This re- evaluation includes the undertaking in its final design, the Area of Potential Effects, and all historic properties present within the APE. Any re-evaluations conducted pursuant to this paragraph shall be submitted to FHWA and SHPO for concurrence and shall be made available to the public upon request.
Retrospective Review. If a health care service has been pre-authorized or approved, the specific standards, criteria or procedures used in the determination shall not be modified pursuant to retrospective review.
Retrospective Review. Within thirty (30) calendar days in accordance with Health and Safety Code Section 1367.01, or any future amendments thereto. Retrospective review applies only to Medi-Cal services, but Contractor may at its discretion apply retrospective review to Medicare services.
Retrospective Review. If Prior Authorization was not performed Cigna will use retrospective review to determine if a scheduled or Emergency admission was Medically Necessary. In the event the services are determined to be Medically Necessary, benefits will be provided as described in this Policy. If it is determined that a service was not Medically Necessary, the Insured Person is responsible for payment of the charges for those services. Following is a Benefit Schedule of the Policy. The Policy sets forth, in more detail, the rights and obligations of both You, Your Family Member(s) and Cigna. It is, therefore, important that all Insured Person's READ THE ENTIRE POLICY CAREFULLY! The benefits outlined in the table below show the payment for Covered Expenses. Coinsurance amounts shown below are Your responsibility after any applicable Deductible, Copayment, have been met, unless otherwise indicated. Copayment amounts shown are also Your responsibility. Your actual expenses for covered services may exceed the stated coinsurance percentage amount because actual provider charges may not be used to determine plan and Insured payment obligations. BENEFIT INFORMATION Note: Covered Services are subject to applicable Annual Deductible and any Additional Deductible(s) unless specifically waived. IN-NETWORK–YOU PAY (Based on Cigna contract allowance) AMOUNTS SHOWN BELOW, INCLUDING DEDUCTIBLE(S), COINSURANCE, COPAYMENTS, ARE THE INSURED PERSON’S RESPONSIBILITY OUT-OF-NETWORK–YOU PAY (Based on Maximum Reimbursable Charge) AMOUNTS SHOWN BELOW, INCLUDING DEDUCTIBLE(S), COINSURANCE, COPAYMENTS, ARE THE INSURED PERSON’S RESPONSIBILITY Medical Benefits NOTE: Treatment in regard to the following will be covered at the plan level for the specific service. The following benefits are covered as mandated by North Carolina: Lymphedema, emergency care, minimum inpatient stay following delivery of a baby, minimum benefits offered for alcoholism/drug abuse treatment, access to non-formulary drugs, hearing aids, bone mass measurement, contraceptives or devices, colorectal cancer screening, newborn hearing screening, ovarian cancer surveillance tests, prostate cancer screening, reconstructive breast surgery following a mastectomy, coverage for congenital defects and anomalies, clinical trials, anesthesia and hospital charges for dental procedures for certain individuals, diabetes, mental illness equity in benefits and minimum coverage requirement, coverage for certain off-label drug use for the treatment ...
