Independent Medical Review definition

Independent Medical Review means an independent evaluation of the medical or chiropractic care of a Member that must include a physical examination of the Member unless he is deceased, and a personal review of all x-rays and reports by a certified Physician or Chiropractor who is formally educated in the applicable medical field.
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Independent Medical Review means an independent evaluation of the medical or chiropractic care of an Insured that must include a physical examination of the Insured unless he is deceased, and a personal review of all x-rays and reports by a certified Physician or Chiropractor who is formally educated in the applicable medical field.
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Independent Medical Review means the analysis of the Treatment by a clinical reviewer of a URAC (formerly known as the Utilization Review Accreditation Commission) accredited independent review organization, who is a board certified physician in the same medical specialty or subspecialty of the underlying Loss, and both external and independent to the Plan and the Administrator.
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Examples of Independent Medical Review in a sentence

  • You may also be eligible for an Independent Medical Review (IMR).

  • If the Member is dissatisfied with the findings of an Independent Medical Review, the Member shall have the right to have the dispute submitted to binding arbitration before an arbiter under the commercial arbitration rules applied by the American Arbitration Association.

  • The Independent Medical Review will include a physical exam of the Member and a personal review of all x-rays and reports made by the primary treating Physician or Chiropractor.

  • The department’s Internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.There is no application or processing fee of any kind associated with the Independent Medical Review process.You may file a grievance with the DMHC if Cigna Dental has not completed the complaint or appeal process described above within 30 days of receiving your grievance.

  • In some cases, the HMO Help Center can help You apply for an Independent Medical Review (IMR) or file a complaint.

  • The CO-OP may require a Member to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits.

  • Independent Medical Review (IMR): A California program where certain denied services may be subject to an external review.

  • HPN may require a Member to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits.

  • It will consider State Fair Hearing and Independent Medical Review (IMR) decisions, and grievances and appeals/complaints data.

  • You are not required to participate in the Health Plan’s grievance process prior to seeking an independent medical review of this decision.The Independent Medical Review Organization will complete its review within 30 days of receipt of your application and supporting documentation.


More Definitions of Independent Medical Review

Independent Medical Review means a process to complete an initial screening of a Covered Person’s grievance.
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Independent Medical Review means a review of the Medical Necessity of the disputed procedure. It does not consider coverage or contract interpretation questions, such as:
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Related to Independent Medical Review

  • Medical Review Officer (MRO) means a licensed physician responsible for receiving and reviewing laboratory results generated by the school district’s drug testing program and for evaluating medical explanations for certain drug tests.

  • District Evaluation Advisory Committee means a group created to oversee and guide the planning and implementation of the Board of Education's evaluation policies and procedures as set forth in N.J.A.C. 6A:10-2.3.

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

  • Independent review organization means an entity that is accredited to conduct independent external reviews of adverse benefit determinations.

  • Independent Manager shall refer to a member of the Board that meets the standards of an “independent director” set forth in NASDAQ Marketplace Rule 4200(a)(15) (on any successor rule) with respect the Company, the Administrator and their respective affiliates. In the event a Special Committee is formed, the term “Independent Manager” shall, as the context requires, refer generically to each Independent Manager.

  • Qualified Medical Practitioner means a medical practitioner who possesses any recognised medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act, 1956 (102 of 1956) and who is enrolled on a State Medical register as defined in clause (k) of that section;