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 General Statutes.
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.
Examples of Medical Necessity or Medically Necessary in a sentence
Types of Utilization Management:• Prior Authorization• Post-Service Medical Necessity Reviews Refer to the definition of Medical Necessity or Medically Necessary in the DEFINITIONS section of this Benefit Booklet for additional information regarding any limitations and/or special conditions pertaining to your benefits.
Medical Necessity or Medically Necessary We reserve the right to determine whether a health care service or supply is Medically Necessary.
Medical Necessity or Medically Necessary means Health Care Services determined by a Practitioner/Provider, in consultation with Presbyterian Insurance Company, Inc.
Medical Necessity or Medically Necessary means Healthcare Services determined by a Practitioner/Provider, in consultation with Presbyterian Insurance Company, Inc.
The facility must be licensed, registered or approved by the Joint Commission on Accreditation of Hospitals or meet specific requirements established by Us. Medical Necessity or Medically Necessary We reserve the right to determine whether a health care service or supply is Medically Necessary.
More Definitions of Medical Necessity or Medically Necessary
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;
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 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 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 and chiropractic communities and not primarily for the convenience of the Member, Member Group, the Participating Payor, CHPC/CSI/PHYS, 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 services or supplies which, under the provisions of this Agreement are: (1) provided for the diagnosis, treatment, cure, or relief of a health condition, illness, injury, or disease; and not for experimental, investigational, or cosmetic purposes; (2) necessary for and appropriate to the diagnosis, treatment, cure, or relief of a health condition, illness, injury, disease, or its symptoms;
Medical Necessity or Medically Necessary means a requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions in the recipient that endanger life, or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no other equally effective, more conservative or substantially less costly course of treatment available or suitable for the person requesting service. "Course of treatment" may include mere observation or, where appropriate no treatment at all. Additionally, the individual must be determined to have a mental illness covered by Washington State for public mental health services. The individual’s impairment(s) and corresponding need(s) must be the result of a mental illness. The intervention is deemed to be reasonably necessary to improve, stabilize or prevent deterioration of functioning resulting from the presence of a mental illness. The individual is expected to benefit from the intervention. Any other formal or informal system or support cannot address the individual’s unmet need.
Medical Necessity or Medically Necessary means clinical determinations to establish a service or benefit which will, or is reasonably expected to: