Utilization Review Requirements Clause Samples

Utilization Review Requirements. Provider shall comply with applicable utilization review requirements set forth in the Massachusetts Code and Regulations, and to the extent necessary, obtain and maintain a utilization review license in the Commonwealth of Massachusetts.
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Utilization Review Requirements. You must follow the requirements of Utilization Review, which are Pre-Admission Review, Pre-Service Approval for certain outpatient services, Concurrent Review and Discharge Planning, and Individual Case Management. If you need non-emergency or non-maternity hospitalization, you or someone on your behalf must call the number on your ID card for pre-approval. Information concerning Utilization Review is detailed in your benefit description and riders. If you do not notify Blue Cross Blue Shield and receive pre-approval, your benefits may be reduced or denied.
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Utilization Review Requirements. The stages of utilization review are pre-service review, care coordination review, and retrospective review. — All scheduled, non-Emergency inpatient Hospital Stays and Residential Treatment Center admissions. Exceptions: Pre-service review is not required for inpatient Hospital Stays for the following services • Maternity care of 48 hours less following a normal delivery or 96 hours or less following a cesarean section, and • Mastectomy and lymph node dissection. — Specific non-Emergency outpatient services, including diagnostic treatment and other services. — Specific outpatient surgeries performed in an outpatient facility of a doctor’s office.
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Related to Utilization Review Requirements

  • System Requirements Apple Software is supported only on Apple-branded hardware that meets specified system requirements as indicated by Apple.

  • Match Requirements There is no match required on the part of the Grantee under this Agreement.

  • Food Service Waste Reduction Requirements Contractor shall comply with the Food Service Waste Reduction Ordinance, as set forth in San Francisco Environment Code Chapter 16, including but not limited to the remedies for noncompliance provided therein.

  • Program Requirements The parties shall comply with the Disadvantaged Business Enterprise Program requirements established in 49 CFR Part 26.

  • Subcontract Requirements As required by Section 6.22(e)(5) of the Administrative Code, Contractor shall insert in every subcontract or other arrangement, which it may make for the performance of Covered Services under this Agreement, a provision that said subcontractor shall pay to all persons performing labor in connection with Covered Services under said subcontract or other arrangement not less than the highest general prevailing rate of wages as fixed and determined by the Board of Supervisors for such labor or services.