Utilization Review Services definition

Utilization Review Services means a service that a Defendant provides to a Payer that establishes mechanisms to monitor and control utilization of health care services and that is designed to control costs and assure quality of care by monitoring over-utilization of health care services, provided that such mechanisms are not used or designed to increase costs or utilization of health care services.
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Utilization Review Services means a service that a Defendant provides to a Payer that establishes mechanisms to monitor and control utilization of health care services and that is designed to control costs and assure quality of care by monitoring
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Utilization Review Services means a plan developed and/or administered by CN, Payor, or a duly designated third party, to monitor and review the delivery of Covered Services to determine whether such services are provided in a cost-efficient and appropriate manner.
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Examples of Utilization Review Services in a sentence

  • Mr. Danso explained the honor of receiving this award.Communications to the Niles City Board of Education—None Res.

  • For Urgent Review of a Prospective Review, a decision and notification of the decision will be made within 24 hours of the date the Cost Containment Administrator receives Notification of Utilization Review Services.

  • My preferred regularization method for one-dimensional problems consists in smoothing the posterior before in- jecting it as prior of the next iteration (but not after the last step!).

  • If a decision cannot be made due to insufficient information, the Cost Containment Administrator will either issue a Noncertification or send an explanation of the information needed to complete the review within 24 hours of receipt of Notification of Utilization Review Services.

  • If a request is made less than 24 hours prior to the expiration of the previously approved period of number of treatments, a decision and notification of the decision will be made within 72 hours of receipt of the Notification of Utilization Review Services.

  • For an initial Prospective Review, a decision and notification of the decision will be made within 15 calendar days of the date the Cost Containment Administrator receives Notification of Utilization Review Services.

  • Utilization Review Services: The Contractor shall be responsible for evaluating situations that may require and/or benefit from referral to the approved UR vendor.

  • For testing purposes, Moss Adams identified complex bills within the sample as those bills that contained several codes or were of high dollar amount, included medical documentation from the provider and contained a certification number from Comprehensive Disability Management (CID), an Aon subcontractor for Utilization Review Services.

  • The response of the Accountant-General indicated that this recommendation had been noted for appropriate action.

  • Completing Utilization Review Services within the time limits and in the manner as set forth in California Labor Code Section 4610, and any other applicable laws.

Related to Utilization Review Services

  • 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.

  • Program services means services that include all of the following provided they are pursuant to a program agreement: program needs assessment and development, job task analysis, curriculum development and revision, instruction, instructional materials and supplies, computer software and upgrades, instructional support, administrative and student services, related school to career training programs, skill or career interest assessment services and testing and contracted services.

  • Support Services the support services, as described in the Support Services Description, that We provide to You in respect of the Cloud Service.

  • Application Review Start Date means the later date of either the date on which the District issues its written notice that the Applicant has submitted a completed Application or the date on which the Comptroller issues its written notice that the Applicant has submitted a completed Application and as further identified in Section 2.3.A of this Agreement.

  • Technical Support Services means the technical support and maintenance Services provided by us according to our then-current technical support policy and procedure listed at xxxxxxxxxxxxx.xxx (“Technical Support Policy”) when the Services are purchased.

  • Hosting Services means the provision, administration, and maintenance of servers and related equipment, the provision of bandwidth at the hosting facility, and the operation of the Application for access by Customer Users to be provided by the relevant hosting service provider.

  • Training Services means access to Red Hat training courses, including online courses or courses provided at a site as may be agreed by the parties.

  • Multiphase professional services contract means a contract for the providing of professional

  • New Services Queue means all Interconnection Requests, Completed Applications, and Upgrade Requests that are received within each six-month period ending on March 31 and September 30 of each year shall collectively comprise a New Services Queue.

  • Related Services means the services incidental to the supply of the goods, such as insurance, delivery, installation, commissioning, training and initial maintenance and other such obligations of the Supplier under the Contract.