External Review definition

External Review means an independent review of an Adverse Benefit Determination conducted by an Independent Review Organization.

External Review means a review that is conducted by an independent review entity which meets specified criteria as established in KRS 304.17A-623, 304.17A-625, and 304.17A-627;

External Review means an independent review of an Adverse Benefit Determination conducted by an Independent Review Organization. External Review is only available for a Final Adverse Benefit Determination based on Medical Necessity, appropriateness, health care setting, level of care, or effectiveness of a Covered Service.

Examples of External Review in a sentence

• If the school completed the Student Performance Diagnostic for the AdvancED External Review, please insert ‘See Student Performance Diagnostic’ in each text box.

• The Claim Administrator must immediately send you a notice of its eligibility determination that meets the requirements set forth in Standard External Review section above.

• Immediately upon receipt of the request for expedited external review, the Claim Administrator must determine whether the request meets the reviewability requirements set forth in the Standard External Review section above.

• Upon a determination that a request is eligible for external review following the preliminary review, the Claim Administrator will assign an IRO pursuant to the requirements set forth in the Standard External Review section above.

• Upon a determination that a request is eligible for external review following the preliminary review, the HMO will assign an IRO pursuant to the requirements set forth in the Standard External Review section above.

More Definitions of External Review

External Review means a review of a non-administrative adverse benefit

External Review means a review by an independent physician as chosen by the Independent Review Organization. “Independent Review Organization” (IRO) means the entity with which the claims administrator has contracted to conduct external reviews for the plan.

External Review means a review conducted by persons from outside the resource center who represent the specialties that are required to be reviewed.

External Review means a school division-level academic review conducted by an organization or agency at the request of a local school board.

External Review means a review of an adverse benefit determination (including a final internal adverse

External Review means a process, independent of all affected parties, to determine if a health care service is medically necessary or experimental/ investigational.

External Review means a review of an adverse