Medically Necessary or Medical Necessity definition

Medically Necessary or Medical Necessity means a treatment, service or supply that is:

Medically Necessary or Medical Necessity means services or supplies which, under the provisions of this Agreement, are determined to be: 2.1.40.1 appropriate and necessary for the symptoms, diagnosis or treatment of the Injury or Illness or dental condition; 2.1.40.2 provided for the diagnosis or direct care and treatment of the Injury or Illness or dental condition; 2.1.40.3 within standards of good medical or dental practice within the organized medical or dental community; 2.1.40.4 not primarily for the convenience of the Covered Person or of any Provider providing Covered Services to the Covered Person; 2.1.40.5 an appropriate supply or level of service needed to provide safe and adequate care; 2.1.40.6 within the scope of the medical or dental specialty, education and training of the Provider; 2.1.40.7 provided in a setting consistent with the required level of care; or

Medically Necessary or Medical Necessity means, with respect to the provision of medical services, supplies and drugs: (a) required by a Member; (b) provided in accordance with recognized professional medical and surgical practices and standards; (c) appropriate and necessary for the symptoms, diagnosis, or treatment of the Member’s medical condition; (d) provided for the diagnosis and direct care and treatment of such medical condition; (e) not furnished primarily for the convenience of the Member, the Member’s family, or the treating provider or other provider; (f) furnished at the most appropriate level that can be provided consistent with generally accepted medical standards of care; and (g) consistent with Blue Shield Medical Policy and Blue Shield Medication Policy.

Examples of Medically Necessary or Medical Necessity in a sentence

• These guidelines are available upon request.• Medically Necessary (or Medical Necessity) means services, treatments, diagnostic procedures, or supplies provided to members that are medically required and appropriate to diagnose and/or treat a member’s physical or mental condition.

• Medical Loss Ratio (MLR) means the calculation the Contractor is required to quantify and report to the Department pursuant to 42 CFR § 438.8. Medically Necessary or Medical Necessity means medically necessary service as defined by Utah Administrative Code R414-1-2.

• MLR is described in Article 12.5. Medically Necessary or Medical Necessity means needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.

• Medically Necessary or Medical Necessity means any medical service that is (1) reasonably calculated to prevent, diagnose, or cure conditions in the Enrollee that endanger life, cause suffering or pain, cause deformity or malfunction, or threaten to cause a handicap; and (2) there is no equally effective course of treatment available or suitable for the Enrollee requesting the service which is more conservative or substantially less costly.

• Medically Necessary or Medical Necessity – See Section 3.4.5 of this Contract.

More Definitions of Medically Necessary or Medical Necessity

Medically Necessary or Medical Necessity means services or supplies which are:

Medically Necessary or Medical Necessity means, with respect to the provision of medical services, supplies and drugs: (a) required by a Member; (b) provided in accordance with recognized professional medical and surgical practices and standards; (c) appropriate and necessary for the symptoms, diagnosis, or treatment of the Member’s medical condition; (d) provided for the diagnosis and direct care and treatment of such medical condition; (e) not furnished primarily for the convenience of the Member, the Member’s family, or the treating provider or other provider; (f) furnished at the most appropriate level that can be provided consistent with generally accepted medical standards of care; and (g) consistent with Blue Shield Medical Policy.

Medically Necessary or Medical Necessity means services or supplies which, under the provisions of this Agreement, are determined to be: 2.1.44.1 appropriate and necessary for the symptoms, diagnosis or treatment of the Injury or Illness or dental condition; 2.1.44.2 provided for the diagnosis or direct care and treatment of the Injury or Illness or dental condition; 2.1. 44.3 within standards of good medical or dental practice within the organized medical or dental community;

Medically Necessary or Medical Necessity means health care services that a Physician, exercising prudent clinical judgement, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an Illness, Injury, disease or its symptoms, and that are:

Medically Necessary or Medical Necessity means health care services, supplies or treatment which, in the judgment of the attending Physician, is appropriate and consistent with the diagnosis and which, in accordance with generally accepted medical standards, could not have been omitted without adversely affecting the Covered Person's condition or the quality of medical care provided.

Medically Necessary or Medical Necessity means services or supplies which under the terms and conditions of this Agreement, are determined to be:

Medically Necessary or Medical Necessity means those covered services that are: