Physician Reviewer definition

Physician Reviewer means a medical doctor, doctor of osteopathy, psychologist, acupuncturist, optometrist, dentist, podiatrist, or chiropractic practitioner licensed in the State of California, competent to evaluate the specific clinical issues involved in the medical treatment services and where these services are within the individual’s scope of practice.
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Physician Reviewer means a medical doctor, doctor of osteopathy, psychologist, acupuncturist, optometrist, dentist, podiatrist, or chiropractic practitioner licensed by any state or the District of Columbia, competent to evaluate the specific clinical issues involved in medical treatment services, where the services are within the individual’s scope of practice.
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Physician Reviewer means a medical director, doctor of osteopathy, psychologist, acupuncturist, optometrist, dentist, podiatrist, or chiropractic practitioner licensed by any state or the District of Columbia, competent to evaluate the specific clinical issues involved in medical treatment services, where these services are within the scope of the reviewer’s practice. Zenith currently utilizes UniMed Direct to conduct these types of reviews.
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Examples of Physician Reviewer in a sentence

  • Physician Reviewer (PR) – external physician reviewing medical records for a variety of reasons.

  • Physician Reviewer determines whether or not service meets the requirements of emergency level 5.

  • The Physician Reviewer chooses the recommendation that is supported with the best available evidence according to the Methodology for Evaluating Medical Evidence set forth in CCR § 9792.25.1.

  • Supporting evidence of the following: • Received Date; • Decision Date; • RN/LVN or Physician Reviewer note from medical management system; and • Proof of date/time letter was mailed to the Member.

  • If the participant or provider continues to disagree with the non-coverage decision, then a request can be made to have the service request reviewed by another Optum Physician Reviewer as an Appeal Review 1.

  • The Physician Reviewer will be in the same profession and in a similar specialty as typically manages the medical, behavioral health, or dental conditions, procedures, and/or treatments under review, as mutually deemed appropriate.

  • In the future, I would like to create a more professional video to engage an audience and promote the importance of cybersecurity awareness in everyday life.

  • If the Care Advocate is not able to authorize benefits for services as requested or negotiate an alternative, the Care Advocate will refer the case to the Optum Alaska Medical Director or Physician Reviewer.A non-coverage determination of services results when the Optum Medical Director or Physician Reviewer reviews a service request and cannot approve the request because it does not meet the medical necessity criteria established for that level of service.

  • If the decision made by the Contract Physician Reviewer is to grant authorization the Contractor’s RN will enter this decision in the MDHHS CHAMPS system and generate an authorization number and communicate this to the physician/designee for DME/MS requests or the VDCU representative in VDCU requests.

  • The citation provided by the Physician Reviewer shall be the primary source relied upon which he or she believes contains the recommendation that guides the reasonableness and necessity of the requested treatment that is applicable to the injured worker's medical condition or injury.


More Definitions of Physician Reviewer

Physician Reviewer means a physician who is appointed by the Practitioner Excellence Committee to conduct case reviews and report his or her findings to the relevant Practitioner Excellence Committee as described more fully in Appendix F.
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Related to Physician Reviewer

  • Physician means a licensed practitioner of medical, surgical, dental, services or the healing arts including accredited Christian Science Practitioner, acting within the scope of his/her license. The treating physician cannot be the Insured, a Traveling Companion, a Family Member, or a Business Partner.

  • Participating physician means a physician licensed in Virginia to practice medicine, who practices

  • Primary care physician means a physician who is a family

  • Attending physician means the physician who has primary

  • Independent physician means a physician who is chosen by the resident of the assisted living facility and who has no financial interest in the assisted living facility, directly or indirectly, as an owner, officer, or employee or as an independent contractor with the residence.

  • PCP means Primary Care Provider.

  • Specialist Physician means a licensed physician who qualifies as an attending physician and who examines a patient at the request of the attending physician or authorized nurse practitioner to aid in evaluation of disability, diagnosis, or provide temporary specialized treatment. A specialist physician may provide specialized treatment for the compensable injury or illness and give advice or an opinion regarding the treatment being rendered, or considered, for a patient’s compensable injury.

  • independent review committee means the independent review committee of the investment fund established under National Instrument 81-107 Independent Review Committee for Investment Funds;

  • 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.

  • Licensed physician means a person licensed to practice

  • Reviewer means the actuary engaged to review or repeat the first actuary’s work, and

  • Medical Review Officer (MRO means a licensed M.D. or D.O. with knowledge of drug abuse disorders, employed or used by the City to review drug results in accordance with this procedure.

  • Collaborating physician means the physician who,

  • Consulting physician means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient's disease.

  • Supervising physician means any physician licensed under Iowa Code chapter 148, 150, or 150A. The supervising physician is responsible for medical direction of emergency medical care personnel when such personnel are providing emergency medical care.

  • Qualified physician means any physician who has not been excluded under the provisions of subpart I of this part. Except as otherwise provided by regulation, a qualified physician shall be deemed to be designated or ap- proved by OWCP.

  • Third party administrator means an administrator operating under a certificate of authority issued by the commissioner pursuant to the third party administrator act.

  • Treating physician means an individual who:

  • Independent testing laboratory means an independent organization, accepted by the Contracting Officer, engaged to perform specific inspections or tests of the work, either at the site or elsewhere, and report the results of these inspections or tests.

  • 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.

  • Medical physicist means a person trained in evaluating the performance of mammography equipment and facility quality assurance programs and who meets the qualifications for a medical physicist set forth in 41.6(3)“c.”

  • Utilization review plan or "plan" means a written procedure for performing review.

  • Third Party Administrator (TPA means any organization or institution that is licensed by the IRDA as a TPA and is engaged by the Company for a fee or remuneration for providing Policy and claims facilitation services to the Insured / Insured Person as well as to the Company for an insurable event.

  • Pharmacist means an individual licensed by this state to compound and dispense drugs, prescriptions, and poisons.

  • Peer-reviewed medical literature means a published scientific study in a journal or other publication in which original manuscripts have been published only after having been critically reviewed for scientific accuracy, validity and reliability by unbiased independent experts, and that has been determined by the international committee of medical journal editors to have met the uniform requirements for manuscripts submitted to biomedical journals. Peer-reviewed medical literature does not include publications or supplements to publications that are sponsored to a significant extent by a pharmaceutical manufacturing company or health carrier.

  • Participating Pharmacy means a pharmacy that has entered into a prescription drug plan agreement with the Pharmacy Benefit Manager listed on your identification card.