Utilization review decision definition

Utilization review decision means a decision pursuant to Labor Code section 4610 to approve, modify, or deny, a treatment recommendation or recommendations by a physician prior to, retrospectively, or concurrent with the provision of medical treatment services pursuant to Labor Code sections 4600 or 5402(c).
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Utilization review decision means a decision pursuant to Section 4610 to modify, delay, or deny, based in whole or in part on medical necessity to cure or relieve, a treatment recommendation or recommendations by a physician prior to, retrospectively, or concurrent with the provision of medical treatment services pursuant to Section 4600 or subdivision (c) of Section 5402.
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Utilization review decision means a decision pursuant to
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Examples of Utilization review decision in a sentence

  • The collaboration between universities in this field is not very frequent although in recent years some joint initiatives are beginning to be more common, as is the example the ACUP, bringing together all the public universities with the purpose to develop joint activities.

  • Utilization review decision making for the Healthy Blue MA plans is based solely on appropriateness of care and service and in accordance with applicable Medicare coverage criteria and guidelines.

  • Utilization review decision making for the Blue Medicare Advantage plans is based solely on appropriateness of care and service and in accordance with applicable Medicare coverage criteria and guidelines.

  • Utilization review decision making for the Anthem MA plans is based solely on appropriateness of care and service and in accordance with applicable Medicare coverage criteria and guidelines.

  • As shown in the previous section, words in Fungwa are mostly bisyllabic, in addition to being onsetful.

  • Utilization review decision making for theBlue Medicare Advantage plans is based solely on appropriateness of care and service and in accordance with applicable Medicare coverage criteria and guidelines.


More Definitions of Utilization review decision

Utilization review decision means a decision pursuant to Labor Code section 4610 to modify, delay, or deny, based in whole or in part on medical necessity to cure or relieve, a treatment recommendation or recommendations by a physician prior to, retrospectively, or concurrent with the provision of medical treatment services pursuant to Labor Code sections 4600 or 5402(c).
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Utilization review decision means a decision pursuant to LC § 4610 to Approve, Modify or Deny, a treatment recommendation or recommendations by a physician prior to, retrospectively, or concurrent with the provision of medical treatment services pursuant to LC §§ 4600 or 5402(c). “Utilization Review Decision” may also mean a determination, occurring on or after January 1, 2018, regarding medication prescribed pursuant to the Drug Formulary.
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Utilization review decision means a decision pursuant to Labor Code section 4610
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Utilization review decision means a decision pursuant to Section 4610 to modify or deny, based in whole or in part on medical necessity to cure or relieve, a treatment recommendation or recommendations by a physician prior to, retrospectively, or concurrent with, the provision of medical treatment services pursuant to Section 4600 or subdivision (c) of Section 5402. “Utilization review decision” may also mean a determination, occurring on or after January 1, 2018, by a physician regarding the medical necessity of medication prescribed pursuant to the drug formulary adopted pursuant to Section 5307.27.
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Utilization review decision means a decision pursuant to Section 4610 to modify, delay, or deny, based in whole or in part on medical necessity
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Utilization review decision means a decision pursuant to Section 4610 to modify, delay, or deny, based in whole or in part on medical necessity to cure or relieve, a treatment recommendation
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Related to Utilization review decision

  • Utilization review means the prospective (prior to), concurrent (during) or retrospective (after) review of any service to determine whether such service was properly authorized, constitutes a medically necessary service for purposes of benefit payment, and is a covered healthcare service under this plan. WE, US, and OUR means Blue Cross & Blue Shield of Rhode Island. WE, US, or OUR will have the same meaning whether italicized or not. YOU and YOUR means the subscriber or member enrolled for coverage under this agreement. YOU and YOUR will have the same meaning whether italicized or not.

  • Utilization review plan or "plan" means a written procedure for performing review.

  • Expedited review means an examination, in accordance with

  • Evaluation Team means the team appointed by the City; “Information Meeting” has the meaning set out in section 2.2;

  • Design Criteria Professional means a firm who holds a current certificate of registration under Chapter 481 of the Florida Statutes, to practice architecture or landscape architecture, or a firm who holds a current certificate as a registered engineer under Chapter 471 of the Florida Statutes, to practice engineering, and who is employed by or under contract to the District to provide professional architect services, landscape architect services, or engineering services in connection with the preparation of the Design Criteria Package.

  • Peer review means evaluation of professional services rendered by a professional practitioner.