Coverage determination definition

Coverage determination means a determination of the circumstances, if any, under which a health technology will be included as a covered benefit in a state purchased health care program.
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Coverage determination means a determination of the circumstances, if any, under which a health technology will be included as a covered benefit in a state purchased health care program, as set forth in RCW 70.14.080, as amended.
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Coverage determination means a determination of a Relevant Minister under Chapter 3 Part 1 Division 1 of the National Gas Law; Covered Pipeline means a pipeline:
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Examples of Coverage determination in a sentence

  • An ICDS Plan’s decision to approve or deny a request for a covered service, also referred to as Coverage Determination.

  • The following materials must be translated into these languages: Summary of Benefits (SB); Annual Notice of Change (ANOC); Evidence of Coverage (i.e., EOC / Participant Handbook); Formulary; Provider and Pharmacy Directory; Part D Transition Letter; Person-Centered Service Plan; Ad-hoc communications regarding payments / reimbursements; Notice described in Section 2.9.3.5; Notices related to Appeals and fair hearings; and Integrated Coverage Determination Notice.

  • Pursuant to ABAG PLAN’s Claim Policy, section 3.3 Coverage Determination, the Town of Woodside exercised its right to appeal the coverage opinion with the Claims Committee.

  • Mailings $2.00 per Client requested letter Creditable Coverage Determination $500 per determination Additional Services To Be Determined * On all claims that provide more than a 30-day supply, maximum caps shall be assessed every four weeks.

  • Pursuant to ABAG PLAN’s Claim Policy, section 3.3 Coverage Determination, the City of American Canyon exercised its right to appeal the coverage opinion with the Claims Committee at their June 22, 2017, meeting.

  • The procedures shall be reviewed based on the supporting documentation available from Qin or under Qin’s control and applicable regulations and guidance, including but not limited to the established practice guidelines and generally accepted standards practice described by the Local Coverage Determination for Dialysis Access Maintenance to determine whether the procedure was medically necessary and appropriate.


More Definitions of Coverage determination

Coverage determination means a determination of the
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Coverage determination as defined in RCW 70.14.080 means a determination of the circumstances, if any, under which a health tech- nology will be included as a covered benefit in a state purchased health care program.
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Coverage determination means a determination of a relevant Minister under Chapter 3 Part 1 Division 1 ; "coverage recommendation" means a recommendation of the NCC under Chapter 3 Part 1 Division 1 ; "coverage revocation determination" means a determination of a relevant Minister under Chapter 3 Part 1 Division 2 ; "coverage revocation recommendation" means a recommendation of the NCC under Chapter 3 Part 1 Division 2 ; "covered pipeline" means a pipeline—
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Coverage determination as defined in RCW 70.14.- 080 means a determination of the circumstances, if any, under which a health technology will be included as a cov- ered benefit in a state purchased health care program((, as set forth in RCW 70.14.080, as amended)).
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Coverage determination. ’ means a determination by
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Coverage determination means with respect to items and services for which coverage may be provided under a health plan, a de- termination of whether or not such items and services are covered or reimbursable under the coverage and terms of the con- tract.
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Related to Coverage determination

  • Adverse determination shall have the meaning set forth in Section 19.7.

  • Claim Determination Period means a calendar year. However, it does not include any part of a year during which a person has no coverage under This Plan, or any part of a year before the date this COB provision or a similar provision takes effect.

  • Self-Determination means a philosophy and process by which individuals with developmental disabilities are empowered to gain control over the selection of support services that meet their needs. The basic principles of self-determination are:

  • Event Determination Date means either:

  • Adverse Benefit Determination means any of the following:

  • SOFR Determination Date has the meaning specified in the definition of “Daily Simple SOFR”.

  • Rate Determination Date means two (2) Business Days prior to the commencement of such Interest Period (or such other day as is generally treated as the rate fixing day by market practice in such interbank market, as determined by the Administrative Agent; provided that to the extent such market practice is not administratively feasible for the Administrative Agent, such other day as otherwise reasonably determined by the Administrative Agent).

  • Index Determination Date means, in relation to any Index, a date on which such Indexfalls to be determined in accordance with the Conditions;

  • Final Determination Date means the following:

  • Expert Determination the process described in Paragraph 6 of Schedule 8.3 (Dispute Resolution Procedure);

  • Extension Determination Date means, in respect of a Series of Covered Bonds, the date falling two Business Days after the expiry of seven days from (and including) the Final Maturity Date of such Covered Bonds.

  • Eligibility Determination means an approval or denial of eligibility and a renewal or termination of eligibility as set forth in OAR 410-200-0015;¶

  • Rate Determination Notice has the meaning specified in Section 3.07(g).

  • Reset Determination Date means, in respect of the First Reset Period, the second Business Day prior to the First Reset Date, in respect of the first Subsequent Reset Period, the second Business Day prior to the Second Reset Date and, in respect of each Subsequent Reset Period thereafter, the second Business Day prior to the first day of each such Subsequent Reset Period;

  • Flood Elevation Determination means a determination by the Administrator of the water surface elevations of the base flood, that is, the flood level that has a one percent or greater chance of occurrence in any given year.

  • Payment Determination Date means, with respect to any Payment Date, one (1) Business Day immediately preceding such Payment Date.

  • Initial determination means the first child custody determination concerning a particular child.

  • Standard of Conduct Determination shall have the meaning ascribed to it in Section 9(b) below.

  • Final Adverse Determination means an Adverse Determination involving a Covered Service that has been upheld by Blue Cross and Blue Shield or its designated utilization review organization, at the completion of Blue Cross and Blue Shield's internal grievance process procedures.

  • Reference Rate Determination Date means, in relation to any Reference Rate Business Day(i):

  • Child custody determination means a judgment, decree, or other order of a court providing for the legal custody, physical custody, or visitation with respect to a child. The term includes a permanent, temporary, initial, and modification order. The term does not include an order relating to child support or other monetary obligation of an individual.

  • Interest Determination Date means, with respect to a Rate of Interest and Interest Accrual Period, the date specified as such hereon or, if none is so specified, (i) the first day of such Interest Accrual Period if the Specified Currency is Sterling or (ii) the day falling two Business Days in London for the Specified Currency prior to the first day of such Interest Accrual Period if the Specified Currency is neither Sterling nor euro or (iii) the day falling two TARGET Business Days prior to the first day of such Interest Accrual Period if the Specified Currency is euro.

  • Final Determination means the final resolution of liability for any Tax for any taxable period, by or as a result of (i) a final and unappealable decision, judgment, decree or other order by any court of competent jurisdiction; (ii) a final settlement with the IRS, a closing agreement or accepted offer in compromise under section 7121 or section 7122 of the Code, or a comparable agreement under the laws of other jurisdictions, which resolves the entire Tax liability for any taxable period; (iii) any allowance of a refund or credit in respect of an overpayment of Tax, but only after the expiration of all periods during which such refund may be recovered by the jurisdiction imposing the Tax; or (iv) any other final disposition, including by reason of the expiration of the applicable statute of limitations.

  • LIBOR Determination Date With respect to any Interest Accrual Period for the LIBOR Certificates, the second London Business Day preceding the commencement of such Interest Accrual Period.

  • Screen Rate Determination is specified in the applicable Final Terms as the manner in which the Rate of Interest is to be determined and the Reference Rate specified in the applicable Final Terms is not XXXXX or SOFR, the Rate of Interest for each Interest Period will, subject as provided below, be either: