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

  • 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.

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

  • The review for an appeal of a clinical based denial is conducted by an appropriate Physician Reviewer who was not involved in or a subordinate of anyone involved in any previous non-authorization (denial/adverse) determination pertaining to the same episode of care and is located in a state or territory of the United States when conducting an appeals review.

  • Only a Kaiser Permanente Utilization Management (UM) Physician Reviewer can deny a service for medical necessity (not clinically indicated).

  • Only a Kaiser Permanente Utilization Management (UM) Physician Reviewer can deny a service for medical necessity (not clinically indicated.

  • A review performed by a Physician Reviewer may result in one of the following outcomes:  Certification - The physician uses the available information and clinical judgment to render a certification determination.

  • 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.

  • Any treatment request which the Nurse Consultant or claims adjuster is not able to approve will be referred to a (Physician) Reviewer or Expert (Physician) Reviewer.QUALITY ASSURANCE Quality Management Program Overview: Policy Statement: Encompass is committed to providing quality services to its customers and consumers.

  • Physician Reviewer Behavioral Health: Licensed, board certified psychiatrists or board certified in a specialty other than psychiatry with additional background and training in substance abuse/addiction treatment.

  • Physician Reviewer (Preservice, Concurrent, Post-Service/Retrospective) Physician Reviewers will evaluate cases based on medical knowledge, experience and current standards of practice.


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 person who:

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

  • Primary care physician means a physician qualified to be an attending physician according to ORS 656.005(12)(b)(A) and who is a general practitioner, family practitioner, or internal medicine practitioner.

  • 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

  • Credentials Committee means the committee established by the Medical Advisory Committee to review applications for appointment and reappointment to the Professional Staff and to make recommendations to the Medical Advisory Committee and if no such committee is established it shall mean the Medical Advisory Committee;

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

  • Medical Review Officer (MRO means a licensed physician, employed with or contracted with the City, responsible for receiving laboratory results generated by the City's drug testing program who has knowledge of substance abuse disorders, laboratory testing procedures, and chain of custody collection procedures; who verifies positive, confirmed test results, and who has the necessary and appropriate medical training to interpret and evaluate an individual's confirmed positive test result together with his or her medical history and any other relevant biomedical information.

  • 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 or "administrator" means the same as that term is defined in Section 31A-1-301.

  • 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 scientific study published only after having been critically