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
Sample 1
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

  • For an Urgent Concurrent Review, a request to extend a course of treatment beyond the period of time or number of treatments previously approved by the Cost Containment Administrator will be decided and notification of the decision will be made within 24 hours of receipt of the Notification of Utilization Review Services if the request is made at least 24 hours prior to the expiration of the previously approved period or number of treatments.

  • For a Retrospective Review, a decision and notification of the decision will be made within 30 calendar days after the date the Cost Containment Administrator receives Notification of Utilization Review Services.

  • 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.

  • 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.

  • 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.

  • Additionally, Surveillance and Utilization Review Services (SURS) are conducted when a provider is cited for multiple service plan deficiencies.

  • Additional ongoing assessments are performed by other entities within the single state Medicaid Agency/Department of Health and Human Services (DHHS) including the Bureau of Licensing and Certification, DHHS Finance Administration, and Utilization Review Services.

  • Level 7 developers know one programming language or technology and are able to develop functional three-tier web applications with special toolkits or frameworks based on that language or technology.

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

Related to Utilization Review Services

  • 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 means support in relation to the use of, and the identification and resolution of errors in, the Hosted Services, but shall not include the provision of training services;

  • Monitoring Services shall have the meaning set forth in Section 2(b) 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.

  • Development Services “Target Market”; “Investment Areas”; and “Targeted Populations” have the meanings ascribed to such terms in 12 C.F.R. 1805.104.

  • 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 shall have the meaning set out in Clause 7.1;

  • Manufacturing Services means the manufacturing, quality control, quality assurance, stability testing, packaging, and related services, as set forth in this Agreement, required to manufacture Product or Products using the Active Materials, Components, and Xxxx Back Items;

  • Contracted Services means covered services that are to be provided by the Contractor under the terms of this Contract.

  • Quality Management System means a set of interrelated or interacting elements that organisations use to direct and control how quality policies are implemented and quality objectives are achieved;

  • Quality Management Plan means the portion of the Project Development Plan providing the information requested in Section 4.3 of Exhibit B to the ITP.

  • IT Services means any services relating to the IT Systems or to any other aspect of the Group’s data processing or other technology requirements, including software development, support or maintenance, consultancy, source code deposit, recovery and network services, facilities management or hardware maintenance; and

  • 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.

  • Passenger Services means, those railway passenger services provided by or on behalf of the Beneficiary pursuant to the permission to use track granted in accordance with the Track Access Agreement;

  • Regulatory Services Provider means the organization which provides regulatory services to BSEF pursuant to a Regulatory Services Agreement.

  • 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.

  • Pharmacy services means the practice of pharmacy as defined in chapter 18.64 RCW and includes any drugs or devices as defined in chapter 18.64 RCW.

  • Child support services means any civil, criminal or administrative action taken by the Division of

  • Engineering Services means infrastructure for –

  • Processing Services means those services which are necessary to issue and service a Card and process a Transaction in accordance with Applicable Law.

  • Design Services means architect services, engineer services or landscape architect services.

  • The Services means those services ancillary to the supply of the Goods, such as transportation and insurance, and any other incidental services, such as installation, commissioning, provision of technical assistance, training, and other such obligations of the Supplier covered under the Contract.

  • 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.

  • Procurement Services shall refer to a business unit of OGS, formerly known as New York State Procurement (“NYSPro”) and Procurement Services Group (“PSG”).