Retrospective Review of Preauthorized Services Sample Clauses

Retrospective Review of Preauthorized Services. We may only reverse a preauthorized treatment, service or procedure on retrospective review when: • The relevant medical information presented to Us upon retrospective review is materially different from the information presented during the Preauthorization review; • The relevant medical information presented to Us upon retrospective review existed at the time of the Preauthorization but was withheld or not made available to Us; • We were not aware of the existence of such information at the time of the Preauthorization review; and • Had We been aware of such information, the treatment, service or procedure being requested would not have been authorized. The determination is made using the same specific standards, criteria or procedures as used during the Preauthorization review.
Sample 1Sample 2Sample 3See All (69)
AutoNDA by SimpleDocs

Related to Retrospective Review of Preauthorized Services

  • Log Reviews All systems processing and/or storing PHI COUNTY discloses to 11 CONTRACTOR or CONTRACTOR creates, receives, maintains, or transmits on behalf of COUNTY 12 must have a routine procedure in place to review system logs for unauthorized access.

  • Personnel Policies The School shall adopt, update, and adhere to personnel policies. These policies must be made readily accessible from the School’s website or school office, as described in Section 11.4.1. If the policy is not available from the School’s website, the School shall submit the current policy to the Commission.

  • Agreed Guidelines Applications With respect to the application of the Sentencing Guidelines to this case, the parties stipulate and agree as follows:

  • Flexible Work Schedule A flexible work schedule is any schedule that is not a regular, alternate, 9/80, or 4/10 work schedule and where the employee is not scheduled to work more than 40 hours in the "workweek" as defined in Subsections F. and H., below.

  • Required Procurement Procedures for Obtaining Goods and Services The Grantee shall provide maximum open competition when procuring goods and services related to the grant-assisted project in accordance with Section 287.057, Florida Statutes.

  • Peer Assistance and Review Program 1. MCEA and MCPS agree to jointly operate a Peer Assistance and Review (PAR) Program. The PAR Program is a mechanism for maintaining systemwide quality control and ensuring that all MCPS teachers responsible for teaching students are functioning at or above the high MCPS standards of performance. It provides intensive assistance for any teacher who has not yet achieved that standard or who falls below acceptable standards. Assistance and review are provided to both experienced MCPS teachers in need of significant improvement and teachers in their first year of teaching.

  • Flexible Work Hours Applicant will encourage its commercial tenants to maintain a flextime and telework policy for those employers/employees for whom it is feasible, to allow work trips of employees to be shifted out of peak travel periods.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!