Medical review
means a clinical evaluation of documentation conducted by AHCCCS or a contractor for purposes of prior authorization, concurrent review, post-payment review, or determining medical necessity. The criteria for medical review are established by AHCCCS or a contractor based on medical practice standards that are updated periodically to reflect changes in medical care.
Medical review
means a process by which certain claims submitted to the Medicaid fiscal agent for payment are reviewed by Agency department medical consultants to determine their final adjudication.
Medical review
means a review involving clinical judgment of a claim or a request for a service before or after it is paid or rendered to ensure that services provided to a member are medically necessary and covered services and that required authorizations are obtained by the provider. The criteria for medical review are established by the contractor based on medical practice standards that are updated periodically to reflect changes in medical care.
Examples of Medical review in a sentence
Medical review for the purpose of fraud, waste, or abuse requires 60 days to allow for the integration of information from the investigative process.
California Department of Managed Health Care 2013 Independent Medical review Summary Report.
Medical review and approval is required for coverage of all Specialty medication prescriptions.
Medical review will be required for additional visits for children.
NOTE: Medical review will be the responsibility of those contractors processing the claims.
More Definitions of Medical review
Medical review
means the procedure for evaluation by health care professionals of the quality and efficiency of services ordered or performed by other health care professionals and such other functions considered to be “peer review” within the meaning of such term as set forth in Section 19a-17b(s) of the Connecticut General Statutes, as amended from time to time. Medical review includes, but is not limited to, credentialing and privileging decisions made pursuant to Article III of these Bylaws, collegial and other informal efforts to improve practitioner performance, and any formal proceedings initiated under Articles IX and X of these Bylaws. Medical review activities shall be kept in strictest confidence.
Medical review
means a clinical evaluation of documenta- tion conducted by AHCCCS or a contractor for purposes of prior authorization, concurrent review, post-payment review, or determining medical necessity. The criteria for medical
Medical review
means the review of a provider’s medical records by, or in consultation with, a medical staff composed of persons who are employed by the [Health
Medical review
means the review of a provider’s medical records by, or in consultation with, [the] a medical staff composed of persons who are employed by the health division [.] or have a contract with the health division for the performance of those services.
Medical review
means the review of a provider’s medical records by, or in consultation with, the medical staff employed by the health division.]
Medical review
means a clinical evaluation of documentation conducted by AHCCCS or a contractor for purposes of prior authorization, concurrent review, post-payment review, or
Medical review
means a review that is done as part of the
