Disputed health care item or service definition

Disputed health care item or service means a health care item or service eligible for coverage and payment under CalCare that has been denied, modified, or delayed by a decision of a participating provider or a health care professional who is employed by or otherwise receives compensation or payment for health care items and services furnished under CalCare from a participating provider, in whole or in part, due to a finding that the service is not medically necessary or appropriate. A decision regarding a disputed health care item or service relates to the practice of medicine, including early discharge from an institutional provider, and is not a coverage decision.
Sample 1Sample 2Sample 3
Disputed health care item or service means a health care
Sample 1Sample 2Sample 3
Disputed health care item or service means a health care item or service eligible for
Sample 1

Related to Disputed health care item or service

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Health-related services means services that may have an effect on the health of individuals but are not health services or social care services;

  • Behavioral health provider means a person licensed under 34 chapter 18.57, 18.57A, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79

  • Health and Human Services Commission or “HHSC” means the administrative agency established under Chapter 531, Texas Government Code, or its designee.