Common use of Medical Necessity Determination Clause in Contracts

Medical Necessity Determination. The Contractor shall determine which services are medically necessary, according to utilization management requirements and the definition of Medically Necessary Services in this Contract. The Contractor’s determination of medical necessity in specific instances shall be final except as specifically provided in this Contract regarding appeals, hearings and independent review.

Medical Necessity Determination. The Contractor shall collect all information necessary to make medical necessity determinations. The Contractor shall determine which services are medically necessary, necessary according to utilization management requirements and the definition of Medically Necessary Services in this Contract. The Contractor’s 's determination of medical necessity in specific instances shall be final final, except as specifically provided in Section 13 of this Contract regarding appeals, hearings and independent reviewContract.

Medical Necessity Determination. The Contractor shall determine which services are medically necessary, according to utilization management requirements and the definition of Medically Necessary Services in this Contract. The Contractor’s determination of medical necessity in specific instances shall be final except as specifically provided in this Contract regarding appeals, fair hearings and independent review.

Medical Necessity Determination. The Contractor shall will collect all information necessary to make medical necessity determinations. (42 C.F.R § 456.111 and 456.211). The Contractor will determine which services are medically necessary, according to utilization management requirements and the definition of Medically Necessary Services in this Contract. The Contractor’s 's determination of medical necessity in specific instances shall will be final except as specifically provided in this Contract regarding appeals, hearings and independent review.

Medical Necessity Determination. The Contractor shall collect all information necessary to make Medical Necessity determinations. The Contractor shall determine which services are medically necessary, Medically Necessary according to utilization management requirements and the definition of Medically Necessary Services in this Contract. The Contractor’s 's determination of medical necessity in specific instances shall be final except as specifically provided in this Contract regarding appeals, hearings Appeals and independent reviewhearings.

Medical Necessity Determination. The Contractor shall collect all information necessary to make Medical Necessity determinations. The Contractor shall determine which services are medically necessary, Medically Necessary according to utilization management requirements and the definition of Medically Necessary Services in this Contract. The Contractor’s 's determination of medical necessity in specific instances shall be final final, except as specifically provided in Section 13 of this Contract regarding appeals, hearings and independent reviewContract.