Urgent Condition definition

Urgent Condition means a health condition including an Urgent Behavioral Health Situation that is not an emergency but is severe or painful enough to cause a prudent layperson, possessing the average knowledge of medicine, to believe that his or her condition requires medical treatment evaluation or treatment within twenty-four (24) hours by the Member’s PCP or PCP designee to prevent serious deterioration of the Member’s condition or health.

Urgent Condition means a situation experienced by a beneficiary that without timely intervention is certain to result in an immediate emergency psychiatric condition.

Urgent Condition means a medical condition is urgent, but not life-threatening. The lack of medical attention within a twenty-four (24) hour period from the start of symptoms could result in further worsening of the patient’s condition. Such conditions may include:

Examples of Urgent Condition in a sentence

• The HMO must have a process in place to handle after-hours inquiries from Providers seeking to verify enrollment for a Member with an Urgent Condition or an Emergency Medical Condition, provided, however, that the HMO and its Providers must not require such verification prior to providing Emergency Services.

• The HMO must ensure that after regular business hours the line is answered by an automated system with the capability to provide callers with operating hours information and instructions on how to verify enrollment for a Member with an Urgent Condition or an Emergency Medical Condition.

• The MCO must ensure that after regular business hours the line is answered by an automated system with the capability to provide callers with operating hours information and instructions on how to verify enrollment for a Member with an Urgent Condition or an Emergency Medical Condition.

• The MCO must have a process in place to handle after-hours inquiries from Providers seeking to verify enrollment for a Member with an Urgent Condition or an Emergency Medical Condition, provided, however, that the MCO and its Providers must not require such verification prior to providing Emergency Services.

• To obtain Urgent Care when you are inside Sharp Health Plan’s Service Area on nights and weekends, the Member must notify his or her Primary Care Dentist, describe the Urgent Condition, and make an appointment to see his or her Primary Care Dentist within 24 hours.

More Definitions of Urgent Condition

Urgent Condition means the rapid onset of symptoms of an illness or injury which requires medical care but is not life-threatening. Within the Service Area, treatment for an Urgent Condition must be obtained from an In-Network Provider. When outside the Service Area, and care cannot be safely delayed until returning to the Service Area, treatment for an Urgent Condition should be obtained from the nearest medical facility. Claims for such care should be submitted to GHC-SCW. GHC- SCW must be notified prior to receiving Out-of-Area Care for an Urgent Condition. If you have an Urgent Condition you should: First CONTACT YOUR PRIMARY CARE CLINIC to see if you can make an appointment with your PCP. If your PCP Is not available, your primary care clinic will instruct you to go to a specified urgent care clinic. Clinic phone lines are answered anytime, day or night. If you are instructed by your PCP to seek services from an Out-of-Network Provider for urgent care, you should contact the GHC-SCW Care Management Department within 48 hours to report that you received services from an Out-of-Network Provider. GHC-SCW will determine benefits at the time of claim.

Urgent Condition means a medical condition manifesting in an urgent, but not life‐threatening condition, such that the absence of medical attention within a 24 hour period from the onset of symptoms could reasonably be expected to result in further complication of the patient’s conditions,

Urgent Condition means a medical condition manifesting in an urgent, but not life- threatening condition, such that the absence of medical attention within a twenty-four

Urgent Condition means a health condition, including an urgent BH situation, that is not an emergency but is severe or painful enough to cause a prudent layperson, possessing the average knowledge of medicine, to believe that his or her condition requires medical treatment evaluation or treatment within 24 hours by the Member’s PCP or PCP designee to prevent serious deterioration of the Member’s condition or health. Utilization Management refers to the Managed Care Organization’s system for retrospective, concurrent, or prospective review of the medical necessity and appropriateness and efficiency of the use of healthcare services, procedures and facilities provided, being provided, or proposed to be provided to a Member. The term includes the following: discharge planning; concurrent planning; precertification; clinical case appeals; proactive processes, such as concurrent clinical reviews and peer reviews; and, appeals introduced by the provider, payer or patient. The term does not include elective requests for clarification of coverage.

Urgent Condition means a condition that is not an emergency medical condition, but which requires prompt medical attention, as determined by a medical, dental or behavioral health provider. Such determination must be provided to the broker at the time of scheduling a trip.

Urgent Condition means a medical condition manifesting in an urgent, but not life-threatening condition, such that the absence of medical attention within a 24 hour period from the onset

Urgent Condition means a situation experienced by a client that, without timely intervention, is certain to result in an immediate emergency psychiatric condition.