Clinical Criteria definition

Clinical Criteria means the criteria used by the Department or the Medically Fragile Children's Unit as described in OAR 411-300-0150 to assess the private duty nursing support needs of a child.

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Clinical Criteria means the written policies, written screening

Clinical Criteria means the written policies, written screening procedures, drug formularies or lists of covered drugs, determination rules, determination abstracts, clinical protocols, practice guidelines, medical protocols and any other criteria or rationale used by the utilization review entity to determine the necessity and appropriateness of covered services.

Examples of Clinical Criteria in a sentence

Clinical Criteria — Criteria used to determine the most clinically appropriate and necessary level of care and intensity of services to ensure the provision of Medically Necessary Services.
Clinical Criteria – criteria used to determine the most clinically appropriate and necessary level of care and intensity of services to ensure the provision of Medically Necessary services.
The Contractor shall: Review and update annually, at a minimum, the Behavioral Health Clinical Criteria and other clinical protocols that the One Care Plan may develop and utilize in its review and submit any modifications to EOHHS annually for review and approval.
The Network Provider agrees to submit claims to Region V for individuals who meet the Clinical Criteria for an identified level of care and the Financial Eligibility Criteria set by DHHS and Region V.
The Network Provider agrees to only submit ▇▇▇▇▇▇▇▇ for services provided to individuals who meet the Clinical Criteria for an identified level of care and the Financial Eligibility Criteria set by DHHS Title 206 Behavioral Health Services Regulation, Region V, or other documents incorporated by reference.

More Definitions of Clinical Criteria

Clinical Criteria means the criteria used by the Department to assess the initial and ongoing eligibility of a child for the Medically Fragile Children’s Program and their support needs.

Clinical Criteria means the criteria used by the Department to assess the nursing support needs of a child annually or as needed for determination of the overall assessed needs of the child.

Clinical Criteria means the written policies, written screening procedures, drug

Clinical Criteria means the criteria used by the Department or the Medically Fragile Children's Unit as described in OAR 411-350-0055 to assess the private duty nursing support needs of an individual aged 18 through 20.

Clinical Criteria means the written policies, written screening procedures, decision rules, decision abstracts, clinical protocols, practice guidelines, and medical protocols used by the utilization review agent to determine the necessity and appropriateness of health care services;

Clinical Criteria means any written policy, written

Clinical Criteria means the written policies, written screening procedures, determination rules, determination abstracts, clinical protocols, practice guidelines, medical protocols, and any other criteria or rationale used for the purposes of utilization management to determine the necessity and appropriateness of covered services.