Medical Necessity or Medically Necessary means health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnose a condition; or to prevent a medical condition from occurring.
Medical Necessity or Medically Necessary means health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnose a condition; or prevent a medical condition from occurring] necessity” or “medically necessary” has the same meaning as provided in section 17b-259b of the Connecticut
Medical Necessity or Medically Necessary means health care provided tocorrect or diminish the adverse effects of a medical condition or mental illness; assist an individual in attaining or maintaining an optimal level of health; diagnose a condition; or prevent a medical condition from occurring;
Examples of Medical Necessity or Medically Necessary in a sentence
Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Insurance Company, Inc.
Medical Necessity or Medically Necessary means Health Care Services determined by a Practitioner/Provider, in consultation with Presbyterian Insurance Company, Inc.
The facility must be licensed, Medical Necessity or Medically Necessary We reserve the right to determine whether a health care service or supply is Medically Necessary.
IMR may only available for certain medical services.• In-Network Benefits: Benefits available to You when You receive services from a Contracted Medical Necessity or Medically Necessary: A Covered Service that meets Plan guidelines for appropriateness and reasonableness by virtue of a clinical review of submitted information.
Those health care services rendered by a Provider that is qualified to furnish such services and are needed to evaluate or stabilize an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine could Medical Necessity or Medically Necessary.
More Definitions of Medical Necessity or Medically Necessary
Medical Necessity or Medically Necessary means health care services determined by a provider, in consultation with the health care insurer, to be appropriate or necessary, according to any applicable generally accepted principles and practices of good medical care or practice guidelines developed by the federal government, national or professional medical societies, boards and associations, or any applicable clinical protocols or practice guidelines developed by the health care insurer consistent with such federal, national, and professional practice guidelines, for the diagnosis, or direct care and treatment of a physical, behavioral, or mental health condition, illness, injury or disease.
Medical Necessity or Medically Necessary means health care provided to correct or diminish the adverse effects of a medical condition or mental illness; assist an individual in attaining or maintaining an optimal level of health; diagnose a condition; or prevent a medical condition from occurring;] “Medicare” means the federal health care program authorized by Title XVIII of the Social Security Act;
Medical Necessity or Medically Necessary means health care provided to correctDepartment of Social Services §17b-262-523or diminish the adverse effects of a medical condition or mental illness; assist an individual in attaining or maintaining an optimal level of health; diagnose a condition; or prevent a medical condition from occurring;
Medical Necessity or Medically Necessary means those Covered Services which are determined to be appropriate and/or necessary for the diagnosis and treatment of a health condition; provided to determine the appropriate diagnosis of a health condition; within the standards of good professional practice within the organized healing arts community and not primarily for the convenience of the Member, Member Group, the Participating Payor, CHPC/CSI, Participating Practitioner or other practitioner; and the most appropriate level of service which can be safely provided as applied to Covered Services.
Medical Necessity or Medically Necessary means appropriate and necessary health care services which are rendered for any condition which, according to generally accepted principles of good medical practice, requires the diagnosis or direct care and treatment of an illness, injury, or pregnancy-related condition, and are not provided only as a convenience.
Medical Necessity or Medically Necessary means clinical determinations to establish a service or benefit which will, or is reasonably expected to:
1. prevent the onset of an illness, condition, or disability;
2. reduce or ameliorate the physical, mental, behavioral, or developmental effects of an illness, condition, injury, or disability;
3. assist the individual to achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the individual and those functional capacities appropriate for individuals of the same age.
Medical Necessity or Medically Necessary means health care services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (1) In accordance with generally accepted standards of medical practice; (2) clinically appropriate, in terms of type, frequency, extent, site and duration and considered effective for the patient’s illness, injury or disease; and (3) not primarily for the convenience of the patient, physician or other health care provider and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease. For the purposes of this section, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community or otherwise consistent with the standards set forth in policy issues involving clinical judgment.