Utilization Management Department definition

Utilization Management Department or “UMD” means appropriately licensed COUNTY staff 8 and/or COUNTY contracted staff responsible for the coordination of services as well as the concurrent 9 and retrospective utilization review of the medical appropriateness, level of care, and utilization of all 10 services provided to MSI Patients by All Providers. 11
Sample 1
Utilization Management Department or “UMD”, referred to as “Case Management Unit” 13 or “CMU” in Prior Agreement, means appropriately licensed COUNTY staff and/or COUNTY 14 contracted staff responsible for the coordination of services as well as the concurrent and retrospective 15 utilization review of the medical appropriateness, level of care, and utilization of all services provided to 16 MSI Patients by All Providers. 17
Sample 1
Utilization Management Department or “UMD” means appropriately licensed COUNTY staff 30 and/or COUNTY contracted staff responsible for the coordination of services as well as the concurrent 31 and retrospective utilization review of the medical appropriateness, level of care, and utilization of all 32 services provided to MSI Patients by All Providers. 33 34 II. CLINIC OBLIGATIONS 35 A. CLINIC, billing for Medical Services for which reimbursement is provided through this 36 Agreement, shall provide Medical Services to all indigent persons covered by this Agreement presenting 37 for treatment. As a condition of reimbursement for Medical Services provided by CLINIC to MSI 1 Eligibles, CLINIC shall comply with this Agreement, including Exhibit E hereto. Claims for such 2 services shall be processed and reimbursed by Intermediary from the appropriate funding category in 3 accordance with Paragraph III. of this Exhibit B to this Agreement. ADMINISTRATOR may direct 4 Intermediary to withhold or delay payment due any CLINIC for failure to comply with the terms of this 5 Agreement. 6 1. Reimbursement provided through this Agreement shall be payment of last resort. CLINIC 7 shall xxxx and attempt collection of third-party or primary other insurance (POI) covered claims to the 8 full extent of such coverage and, upon submission of any claim, shall submit to Intermediary, proper 9 documentation demonstrating compliance with this requirement. 10 2. Acceptance by CLINIC of reimbursement made by Intermediary for services provided in 11 accordance with this Agreement shall be deemed satisfaction in full, with respect to the services for 12 which payment was made, except as follows: 13 a. Claims covered by any third-party, primary, or other insurance or a third-party 14 settlement, include those received by or on behalf of an MSI Patient. CLINIC shall attempt to xxxx and 15 collect to the full extent of coverage those claims covered by all known third-party, primary, or other 16 insurance or third-party payors. If CLINIC becomes aware of any third-party, primary, or other 17 insurance or a third-party settlement, including those received by or on behalf of an MSI Patient after 18 reimbursement is made by Intermediary, nothing herein shall prevent CLINIC from pursuing 19 reimbursement from these sources; provided, however, that CLINIC shall comply with Paragraph
Sample 1

Examples of Utilization Management Department in a sentence

  • You may also write CareCheck® at Quality Utilization Management Department, 8170 33rd Avenue South, P.O. Box 1309, Minneapolis, MN 55440-1309.

  • If the question is about a specific utilization case or decision that cannot be answered by Customer Service, the Member’s call will be forwarded to the Utilization Management Department.

  • You may also write CareCheck® at Quality Utilization Management Department, 0000 00xx Xxxxxx Xxxxx, X.X. Box 1309, Minneapolis, MN 55440-1309.

  • Healthcare Utilization Management The Healthcare Utilization Management Department coordinates requests for referral authorization and clinical utilization management of members to promote medically necessary high-quality care in an optimal setting.

  • These forms are intended to provide authorization for treatment and care.Please call the Utilization Management Department at Kaiser Permanente for questions regarding services authorized.

  • Please call Healthy U’s Utilization Management Department for questions concerning enhanced services.Information about HIV and sexually transmitted infections are provided to members of the “U Baby Care” program.Healthy U requires providers to conduct a risk assessment on every pregnant member.

  • Site visits will be performed by CENTURION OF MISSOURI Utilization Management Department staff.

  • SWMBH’s Utilization Management Department consists of appropriately credentialed staff that is deemed capable by the Medical Director and Manager of UM and Call Center in making medical necessity determinations for the services that they authorize.

  • The Utilization Management Department will evaluate the need for additional programs (or enhancement of current programs) to increase customer satisfaction at all levels, i.e., members, providers and employer groups.

  • Clinical Coordinators in the Utilization Management Department will issue an authorization for the ambulance transfer.

Related to Utilization Management Department

  • Utilization management section means “you or your authorized representative.” Your representative will also receive all notices and benefit determinations.

  • Fire Department means an organized fire department as that term is defined in section 1 of the fire prevention code, 1941 PA 207, MCL 29.1.

  • Stormwater management BMP means an excavation or embankment and related areas designed to retain stormwater runoff. A stormwater management BMP may either be normally dry (that is, a detention basin or infiltration system), retain water in a permanent pool (a retention basin), or be planted mainly with wetland vegetation (most constructed stormwater wetlands).

  • Virginia Stormwater Management Program or “VSMP” means a program approved by the State Board after September 13, 2011, that has been established by a locality to manage the quality and quantity of runoff resulting from land-disturbing activities and shall include such items as local ordinances, rules, permit requirements, annual standards and specifications, policies and guidelines, technical materials, and requirements for plan review, inspection, enforcement, where authorized in this article, and evaluation consistent with the requirements of this article and associated regulations.

  • Finance Department means the Finance Department of the Government of Assam;

  • Virginia Stormwater Management Program authority or "VSMP authority" means an authority approved by the State Board after September 13, 2011, to operate a Virginia Stormwater Management Program.

  • Stormwater management planning agency means a public body authorized by legislation to prepare stormwater management plans.

  • New Jersey Stormwater Best Management Practices (BMP) Manual or “BMP Manual” means the manual maintained by the Department providing, in part, design specifications, removal rates, calculation methods, and soil testing procedures approved by the Department as being capable of contributing to the achievement of the stormwater management standards specified in this chapter. The BMP Manual is periodically amended by the Department as necessary to provide design specifications on additional best management practices and new information on already included practices reflecting the best available current information regarding the particular practice and the Department’s determination as to the ability of that best management practice to contribute to compliance with the standards contained in this chapter. Alternative stormwater management measures, removal rates, or calculation methods may be utilized, subject to any limitations specified in this chapter, provided the design engineer demonstrates to the municipality, in accordance with Section IV.F. of this ordinance and N.J.A.C. 7:8-5.2(g), that the proposed measure and its design will contribute to achievement of the design and performance standards established by this chapter.

  • Police Department means the Police Department of the City and County of San Francisco.

  • Stormwater management system means any equipment, plants,

  • Stormwater management plan means the set of drawings and other documents that comprise all the information and specifications for the programs, drainage systems, structures, BMPs, concepts and techniques intended to maintain or restore quality and quantity of stormwater runoff to pre-development levels.

  • Local health department means the same as that term is defined in Section 26A-1-102.

  • Public Finance Management Act ’ means the Public Finance Management Act, 1999 (Act No. 1 of 1999);

  • Stormwater management means the programs to maintain quality and quantity of stormwater runoff to pre-development levels.

  • Number Portability Administration Center or "NPAC" means one (1) of the seven (7) regional number portability centers involved in the dissemination of data associated with ported numbers. The NPACs were established for each of the seven (7) original Xxxx Operating Company regions so as to cover the fifty (50) states, the District of Columbia and the U.S. territories in the North American Numbering Plan area. "Numbering Plan Area" or "NPA" is also sometimes referred to as an area code. It is a unique three-digit indicator that is defined by the "X," "X" and "C" digits of each 10-digit telephone number within the NANP. Each NPA contains 800 possible NXX Codes. There are two (2) general categories of NPA. "Geographic NPA" is associated with a defined geographic area and all telephone numbers bearing such NPA are associated with services provided within that geographic area. A "Non-Geographic NPA," also known as a "Service Access Code" (SAC Code), is typically associated with a specialized Telecommunications Service which may be provided across multiple geographic NPA areas; 500, Toll Free Service NPAs, 700, and 900 are examples of Non-Geographic NPAs. "NXX," "NXX Code," "Central Office Code," or "CO Code" is the three- (3)-digit Switch entity code which is defined by the "D," "E" and "F" digits of a ten- (10) digit telephone number within the NANP. "Operational Support Systems" or "OSS" shall have the meaning set forth in Section 12. "Optional Testing" is testing conducted by CenturyLink, at the request of CLEC, that is in lieu of testing CLEC should complete to isolate trouble to the CenturyLink network prior to submitting a trouble ticket to CenturyLink.

  • Project Management Report means each report prepared in accordance with Section 4.02 of this Agreement;

  • Health Department means the department of environmental quality, a city health department, a county health department, or a district health department, whichever has jurisdiction.

  • Case management services means planned referral, linkage, monitoring and support, and advocacy provided in partnership with a consumer to assist that consumer with self sufficiency and community tenure and take place in the individual’s home, in the community, or in the facility, in accordance with a service plan developed with and approved by the consumer and qualified staff.

  • Stormwater management planning area means the geographic area for which a stormwater management planning agency is authorized to prepare stormwater management plans, or a specific portion of that area identified in a stormwater management plan prepared by that agency.

  • Project Management Plan means the portion of the Project Development Plan providing the information requested in Section 4.2 of Exhibit B to the ITP.

  • Head of the Department means the administrative head of the department or the organization;

  • Project Management The individuals appointed by each Party cf. clause 4.1 in the Agreement.

  • Local department means the local department of social services of any county or city in this

  • Contracting Department any contracting authority as defined in Regulation 5(2) of the Public Contracts (Works, Services and Supply) (Amendment) Regulations 2000 other than the Department; "Contractor Personnel" all employees, agents, consultants and contractors of the Contractor and/or of any Sub-contractor; "Contractor Software" software which is proprietary to the Contractor, including software which is or will be used by the Contractor for the purposes of providing the Services; "Crown Body" any department, office or agency of the Crown;

  • Case management means a care management plan developed for a Member whose diagnosis requires timely coordination. All benefits, including travel and lodging, are limited to Covered Services that are Medically Necessary and set forth in the EOC. KFHPWA may review a Member's medical records for the purpose of verifying delivery and coverage of services and items. Based on a prospective, concurrent or retrospective review, KFHPWA may deny coverage if, in its determination, such services are not Medically Necessary. Such determination shall be based on established clinical criteria and may require Preauthorization.

  • Floodplain Management means the operation of an overall program of corrective and preventive measures for reducing flood damage, including but not limited to emergency preparedness plans, flood control works and floodplain management regulations.