External review organization definition
External review organization means an entity that conducts independent external reviews of adverse decisions pursuant to a contract with the commissioner. Such entity shall be a nationally accredited external review organization which utilizes health care providers actively engaged in the practice of their profession in the state of Kansas who are qualified and credentialed with respect to the health care service review. In the event the entity has no Kansas providers available who are qualified and credentialed with respect to the review of any case, the external review organization shall have the discretion to employ health care providers who actively engage in such health care provider's practice outside the state of Kansas.
External review organization means an entity that conducts independent external reviews of adverse determinations and final adverse determinations of a health carrier;
External review organization means an entity that conducts independent external reviews of adverse determinations and final adverse determinations and whose accreditation or certification has been reviewed and approved by the Department of Insurance.
More Definitions of External review organization
External review organization means an entity that conducts independent external reviews of adverse decisions pursuant to a contract with the commissioner. Such entity shall have
External review organization means an organization that has contracted with a hospital to provide external review of PCI cases and that maintains appropriate oversight of each external reviewer who evaluates PCI cases for a hospital. The term includes an
External review organization means an entity that conducts independent external reviews of adverse determinations and final adverse determinations of a health carrier regarding medical necessity, appropriateness, healthcare setting, level of care or effectiveness of a healthcare service or treatment, or healthcare provider compensation;
External review organization means an entity that conducts independent external