Review agent definition

Review agent means a person or entity or insurer performing utilization review that
Review agent means a person or health care entity performing benefit determination
Review agent means a person or entity performing service review activities within one year of the date of a fully compliant application for licensure who is either affiliated with, under contract with, or acting on behalf of a business entity in this state; or a third party State and who provides or administers mental health care benefits to citizens of Vermont members of health benefit plans subject to the Department’s jurisdiction, including a health insurer, nonprofit health service plan, health insurance service organization, health maintenance organization or preferred provider organization, including organizations that rely upon primary care physicians to coordinate delivery of services, authorized to offer health insurance policies or contracts in Vermont.

Examples of Review agent in a sentence

  • Within 5 business days after receiving a written appeal of the adverse determination, we or our Utilization Review agent will send you, your designated representative, or your unborn child’s physician or perinatal provider, a letter acknowledging the date of receipt of the appeal.

  • An adverse determination is a decision that is made by us or our Utilization Review agent that the health-care services furnished or proposed to be furnished to your unborn child are not medically necessary or appropriate.

  • When we or our Utilization Review agent deny the appeal, you, your designated representative, or you unborn child’s physician or perinatal provider will receive information on how to request an IRO review of the denial and the forms that must be completed and returned to begin the independent review process.

  • In life-threatening situations, you, your designated representative, or your unborn child’s physician or Perinatal provider of record may contact us or our Utilization Review agent by telephone to request the review by the IRO; and we or our Utilization Review agent will provide the required information.

  • The letter will also include a list of documents that you, your designated representative or your unborn child’s physician or prenatal care provider should send to us or to our Utilization Review agent for the appeal.


More Definitions of Review agent

Review agent means a person or entity performing service review
Review agent or “review agency” means a person or entity or insurer performing utilization review that is either employed by, affiliated with, under contract with, or acting on behalf of:
Review agent means a person or entity or insurer performing utilization
Review agent means a person or entity performing service review activities within one year of the date of a fully compliant application for licensure who is either affiliated with, under contract with, or acting on behalf of a business entity in this state; or a third party State and who provides or administers mental health care benefits to citizens of Vermont members of
Review agent has the meaning specified in Section 3.09(a).
Review agent means a hospital or nonhospital-affiliated person or entity performing utilization review or managed care that is either affiliated with, under contract with, or acting on behalf of:
Review agent means a person or health-care entity performing benefit determination reviews that is either employed by, affiliated with, under contract with, or acting on behalf of a health-care entity.