Health Care Services Review definition

Health Care Services Review means the review of any proposed or actual medical services, including necessity of Professional Health Care Services, quality of Professional Health Care Services, utilization of Professional Health Care Services and interpretation and application of preconditions for coverage, such as precertification or second opinions.

Examples of Health Care Services Review in a sentence

  • RMS is able to transmit Health Insurance Portability and Accountability Act (HIPAA) compliant 278 Health Care Services Review Request for Review and Response transactions.

  • Send and Receive 278 Requests; Send and Receive 278 Responses] • The ASC X12N 278 - Health Care Services Review - Request for Review and Response, Version 5010.

  • The Health Care Services Review (278) request transaction is utilized by providers and facilities to request reviews for specialty care and admissions.

  • Receive 278 Requests and Send 278 Responses] • The ASC X12N 278 - Health Care Services Review - Request for Review and Response, Version 5010.

  • The Health Care Services Review (278) response is utilized by Utilization Management Organizations (UMOs) to response with results for reviews for specialty care and admissions.

  • Receive 278 Requests and Send 278 Responses] • The ASC X12N 278 - Health Care Services Review - Request for Review and Response, most currently adopted version.

  • Send and Receive 278 Requests; Send and Receive 278 Responses] • The ASC X12N 278 - Health Care Services Review - Request for Review and Response, most currently adopted version.

  • The May 2006 ASC X12 005010X217 Implementation Guide is the primary source for definitions, data usage and requirements.This section and the corresponding transaction data detail make up the companion guide for submitting and receiving Health Care Services Review (278) requests and responses for patients with Highmark benefit plans, Federal Employees Health Benefit Plan and BlueCard Par Point of Service (POS).

  • The Additional Information to Support a Health Care Services Review (275) request transaction is utilized by providers and facilities to send additional information about a services review/prior authorization request.

  • The prior authorization standard incorporates real-time prior authorization functionality in the ASC X12N 278 Health Care Services Review transaction.

Related to Health Care Services Review

  • Health care services means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.

  • Child care services means the range of activities and programs provided by a certificate holder to an enrolled child, including personal care, supervision, education, guidance, and transportation.

  • Primary care services means the services in respect of which NHS England has a duty or power to make arrangements pursuant to the Primary Care Functions;

  • Home health care services means medical and nonmedical services, provided to ill, disabled or infirm persons in their residences. Such services may include homemaker services, assistance with activities of daily living and respite care services.

  • Health care service means that service offered or provided by health care facilities and health care providers relating to the prevention, cure, or treatment of illness, injury, or disease.

  • Basic health care services means in and out-of-area emergency services, inpatient hospital and

  • Day-care services means care of a child for a portion of the day which is less

  • PREVENTIVE CARE SERVICES means covered healthcare services performed to prevent the occurrence of disease as defined by the Affordable Care Act (ACA). See Preventive Care and Early Detection Services in Section 3. PRIMARY CARE PROVIDER (PCP) means, for the purpose of this plan, professional providers that are family practitioners, internists, and pediatricians. For the purpose of this plan, gynecologists, obstetricians, nurse practitioners, and physician assistants may be credentialed as PCPs. To find a PCP or check that your provider is a PCP, please use the “Find a Doctor” tool on our website or call Customer Service.

  • Home care services means skilled or personal care

  • Foster care services means the provision of a full range of casework, treatment and community

  • Personal care services means both physical assis- tance and/or prompting and supervising the performance of direct personal care tasks as determined by the resident's needs and does not include assistance with tasks performed by a licensed health professional.

  • Healthcare services means all inpatient services (i.e., acute-care diagnostic and therapeutic inpatient hospital services), outpatient services (i.e., acute-care diagnostic and therapeutic outpatient services, including but not limited to ambulatory surgery and radiology services), and professional services (i.e., medical services provided by physicians or other licensed medical professionals) to the extent offered by Defendant and within the scope of services covered on an in-network basis pursuant to a contract between Defendant and an Insurer. “Healthcare Services” does not mean management of patient care, such as through population health programs or employee or group wellness programs.

  • Health care provider or "provider" means:

  • Child welfare services means social services including

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • COVERED HEALTHCARE SERVICES means any service, treatment, procedure, facility, equipment, drug, device, or supply that we have reviewed and determined is eligible for reimbursement under this plan.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Long-term care services means services provided through the department of social and health services either in a hospital or skilled nursing facility, or in another setting under a home and community-based waiver authorized under 42 U.S.C. Sec. 1396n.

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Child Care Program means a person or business that offers child care.

  • Primary care provider means a participating provider who supervises, coordinates, or provides initial care or continuing care to a covered person, and who may be required by the health carrier to initiate a referral for specialty care and maintain supervision of health care services rendered to the covered person.

  • Health care system means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for or payment for, in full or in part, health care services or health care data or health care information for its participants;

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

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Health care professional means a physician or other health care practitioner licensed, accredited or certified to perform specified health care services consistent with state law.