External Exception Review definition

External Exception Review. If an exception is not authorized for a non-formulary drug, a Member, a Member’s designee, or a prescribing physician may request a second level exception denial review by an external independent review. Organization (IRO) not legally affiliated with or controlled by KFHPWA. The IRO will provide its determination to the Member, Member designee and the prescribing physician no later than 72 hours of receipt of the request after receipt of information sufficient to make a decision. For expedited reviews, the IRO will provide a determination no later than 24 hours after the receipt of the request after receipt of information sufficient to make a decision.

Examples of External Exception Review in a sentence

  • If coverage is denied, KFHPWA will provide notification of the adverse determination to the prescribing physician and the member External Exception Review: If an exception is not authorized for a non-formulary drug, a Member, a Member’s designee, or a prescribing physician may request a second level exception denial review by an external independent review.

Related to External Exception Review

  • External inspection means an inspection made when a boiler is in operation.

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  • Independent testing laboratory means an independent organization, accepted by the Contracting Officer, engaged to perform specific inspections or tests of the work, either at the site or elsewhere, and report the results of these inspections or tests.

  • Utilization review plan or "plan" means a written procedure for performing review.

  • Peer-reviewed medical literature means a scientific study published only after having been critically

  • Internal combustion engine or ‘engine’ means an energy converter, other than a gas turbine, designed to transform chemical energy (input) into mechanical energy (output) with an internal combustion process; it includes, where they have been installed, the emission control system and the communication interface (hardware and messages) between the engine's electronic control unit(s) and any other powertrain or non-road mobile machinery control unit necessary to comply with Chapters II and III;

  • Peer review means evaluation of professional services rendered by a professional practitioner.

  • external engineering service means an engineering service situated outside the boundaries of a land area and that is necessary to serve the use and development of the land area;

  • Peer support specialist means an individual who has experienced a severe and persistent mental illness and who has successfully completed standardized training to provide peer support services through the medical assistance program or the Iowa Behavioral Health Care Plan.

  • External Verifier means a qualified provider of third-party assurance or attestation services appointed by the Guarantor to review the Guarantor's statement of the Sustainability Performance Targets.

  • Safeguards Monitoring Report means each report prepared and submitted by the Borrower to ADB that describes progress with implementation of and compliance with the EMP and the RP, including any corrective and preventative actions;

  • CREFC® Significant Insurance Event Template A report substantially in the form of, and containing the information called for in, the downloadable form of the “Interest Significant Insurance Event Template” available as of the Closing Date on the CREFC® Website, or such other form for the presentation of such information and containing such additional information as may from time to time be approved by the CREFC® for commercial mortgage securities transactions generally.

  • independent review committee means the independent review committee of the investment fund established under National Instrument 81-107 Independent Review Committee for Investment Funds;

  • Independent Software Vendor or “ISV” means a Person that makes available to Participants and Authorized Traders a system or platform offering smart order routing, front-end trading applications, an aggregation platform or a combination of the foregoing but that does not provide Participants or Authorized Traders with the ability to effect transactions other than through the Trading System.

  • Root Cause Analysis Report means a report addressing a problem or non-conformance, in order to get to the ‘root cause’ of the problem, which thereby assists in correcting or eliminating the cause, and prevent the problem from recurring.

  • Evaluation Committee Report means a report prepared by the Procurement Manager and the Evaluation Committee for contract award. It will contain written determinations resulting from the procurement.

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  • Participating Certified Clinical Nurse Specialist means a Certified Clinical Nurse Specialist who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Peer review committee means one or more persons acting in a peer review capacity who also serve as an officer, director, trustee, agent, or member of any of the following:

  • Automated external defibrillator means a defibrillator device to which all of the following apply:

  • Major Decision Reporting Package With respect to any Major Decision, (a) a written report prepared by the Special Servicer describing in reasonable detail (i) the background and circumstances requiring action of the Special Servicer, (ii) the proposed course of action recommended, and (iii) information regarding any direct or indirect conflict of interest in the subject action, and (b) all information in the Special Servicer’s possession that is reasonably requested by the party receiving such Major Decision Reporting Package in order for such party to exercise any consultation or consent rights available to such party under this Agreement.