Retrospective review definition

Retrospective review means a review of medical necessity conducted after services have been provided to a patient, but does not include the review of a claim that is limited to an evaluation of reimbursement levels, veracity of documentation, accuracy of coding, or adjudication for payment.

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Retrospective review means utilization review conducted after medical services have been provided and for which approval has not already been given.

Retrospective review means the process of reviewing the medical necessity and reasonableness of health care that has been provided to an injured employee.

Examples of Retrospective review in a sentence

The Contractor shall have the capability and established procedures to receive Retrospective review request for Inpatient and Outpatient services within sixty (60) days of the service date and conduct prepayment reviews.
Retrospective review is performed when Keystone receives a claim for payment for services that have already been provided.
Retrospective review includes a medical necessity evaluation of the care/service provided to the member, and of physician compliance to the Utilization/Case Management Program Requirements.
The INSURER will establish a Retrospective review Program that will address quality and utilization problems that may arise, as described in the INSURER's Proposal.
Retrospective review applies only to Medi-Cal services, but Contractor may at its discretion apply retrospective review to Medicare services.

More Definitions of Retrospective review

Retrospective review means utilization review that is conducted after health care services have been provided to a covered person. "Retrospective review" does not include the review of a claim that is limited to an evaluation of reimbursement levels, or adjudication of payment;

Retrospective review means any review of a request for a benefit that is not a prospective review request. Retrospective review does not include the review of a claim that is limited to veracity of documentation or accuracy of coding; and

Retrospective review means a review conducted after services have been provided to a covered person.

Retrospective review means a review, for coverage purposes, of medical necessity conducted after services have been provided to a patient.

Retrospective review means utilization review that is conducted after health care

Retrospective review means the review conducted after services are provided to a client, to determine the medical necessity, appropriateness, and quality of the services provided.

Retrospective review means a review of medical necessity conducted after services have been