Utilization Review Committee definition

Utilization Review Committee is an IPA committee of at least three (3) Member Physicians which is established and maintained, in accordance with the provisions of Section 3.13 herein, to develop a utilization control program outlining procedures for the efficient use of resources, consistent with state and federal law, for the rendition of Medical Services. The Utilization Review Committee shall review elective Referrals and hospital admissions on a concurrent and prospective basis and Emergency Services, Urgently Needed Services and hospital admissions on a retrospective basis.

Utilization Review Committee means a committee that reviews services provided to determine appropriateness for psychiatric inpatient hospital services, identifies problems with quality of care, and meets the requirements of Title 42, CFR, Chapter IV, Subchapter C, Part 456, Subpart D (CCR §1820.200).

Utilization Review Committee means a committee that reviews services provided to determine appropriateness for psychiatric inpatient hospital services, identifies problems with quality of care, and meets the requirements of Title 42, Code of Federal Regulations, Chapter IV, Subchapter C, Part 456, Subpart D.

Examples of Utilization Review Committee in a sentence

• The board shall establish a Senior Drug Utilization Review Committee to address the specific prescribing needs of the elderly and an AIDS/HIV Drug Utilization Review Committee to address the specific prescribing needs of persons with AIDS/HIV, in addition to such other committees as it deems necessary.

• The Utilization Management for all service providers (outpatient, crisis residential, case management) includes procedures for establishing a Utilization Review Committee (URC), standards for participation in the URC, logs for URC activities, and standards for authorization.

• Utilization Review Committee (URC) Programs are required to have an internal URC in place to review records and conduct UM process.

• Clients shall meet specific criteria and be reviewed through a Utilization Management (UM) process which shall be conducted internally by a Utilization Review Committee (URC) at all County and county contracted outpatient clinics.

• If a client receives a MORS rating of 6 to 8 but the primary provider believes that the client should continue to receive services at the county or contracted outpatient clinic the primary provider may request Utilization Review Committee (URC) to review client’s case and justify ongoing services if applicable.

• After a case study, the heuristics were expanded.Of the selected heuristics, this is one of two that is explicitly created with the goal of measuring the UX.

• However, by enrolling in HEALTH PLAN, YOU authorize the release of information, as permitted by law, and access to any and all of medical records of YOUR CHILD for purposes reasonably related to the provision of services under this Contract, to HEALTH PLAN, its agents and employees, YOUR CHILD'S Primary Care Physician or Primary Care Provider, participating Providers, outside Providers of Utilization Review Committee, CHIP and appropriate governmental agencies.

• Utilization Review for Crisis Residential Programs Each crisis residential program, referred to as Short Term Acute Residential Treatment (START) program, shall convene a Utilization Review Committee (URC) to review all admitted clients in order to justify medical necessity and obtain authorization for continued services concurrently with the client’s stay.

• The Medical Director and/or HPN's Utilization Review Committee will review proposed services and supplies to be received by a Member to determine:  If the services are Medically Necessary and/or appropriate.

• Each hospital shall establish a Utilization Review Committee to determine whether admission and length of stay are appropriate to level of care and to identify problems with quality of care.