Utilization Review. (a) An MA Organization for an MA coordinated care plan must use written protocols for utilization review and policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services and have in effect mechanisms to detect both underutilization and over utilization of services. [422.152(b)]
Appears in 19 contracts
Samples: HealthSpring, Inc., HealthSpring, Inc., Wellcare Health Plans, Inc.
Utilization Review. (a) An Art MA Organization for an MA coordinated care plan must use written protocols for utilization review and policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services and have in effect mechanisms to detect both underutilization and over utilization of services. [422.152(b)]
Appears in 1 contract
Samples: Wellcare Health Plans, Inc.