Utilization Review and Control. In accordance with 42 CFR §438.210(a)(4), the MCO may place appropriate limits on the covered services provided under this Contract on the basis of criteria applied under the Medicaid State Plan, such as medical necessity or for the purpose of utilization control, provided that:
Appears in 3 contracts
Samples: Model Purchase of Service Provider Agreement, Service Provider Agreement, Model Purchase of Service Provider Agreement
Utilization Review and Control. In accordance with 42 CFR §438.210(a)(4), the MCO may place appropriate limits on the covered services provided under this Contract on the basis of criteria applied under the Medicaid and WVCHIP State PlanPlans, such as medical necessity or for the purpose of utilization control, provided that:
Appears in 3 contracts
Samples: Service Provider Agreement, Service Provider Agreement, Service Provider Agreement
Utilization Review and Control. In accordance with 42 CFR §438.210(a)(4), the MCO may place appropriate limits on the covered services provided under this Contract on the basis of criteria applied under the Medicaid or BSS State PlanPlans, such as medical necessity or for the purpose of utilization control, provided that:
Appears in 1 contract
Samples: dhhr.wv.gov
Utilization Review and Control. In accordance with 42 CFR §438.210(a)(4), the MCO may place appropriate limits on the covered services provided under this Contract on the basis of criteria applied under the Medicaid or BCF State PlanPlans, such as medical necessity or for the purpose of utilization control, provided that:
Appears in 1 contract
Samples: Service Provider Agreement
