Care Coordination Reviews Sample Clauses

Care Coordination Reviews. If pre-service review was not performed, the Member, the Member's Physician or the provider of service must contact Anthem Blue Cross for care coordination review. For an Emergency Hospital admission or procedure, Anthem Blue Cross must be notified within one working day of the admission or procedure, unless extraordinary circumstances* prevent such notification within that time period. The toll-free telephone number for concurrent review is 0-000-000-0000. When a Prudent Buyer Plan Provider has been informed of the Member's need for utilization review, they will initiate the review on the Member's behalf. The Member may ask a Non-Prudent Buyer Plan Provider to call the toll free number, or the Member may call Anthem Blue Cross directly. When Anthem Blue Cross determines that the service is Medically Necessary and appropriate, Anthem Blue Cross will, depending upon the type of treatment or procedure, specify the period of time for which the service is medically appropriate. Also, Anthem Blue Cross will determine the medically appropriate setting. If Anthem Blue Cross determines that the service is not Medically Necessary and appropriate, the Member’s Physician will be notified by telephone no later than 24 hours following Anthem Blue Cross’ decision. Written notice will be sent to the Member and the Member's Physician within two business days following Anthem Blue Cross’ decision. However, care will not be discontinued until the Member’s Physician has been notified and a plan of care that is appropriate for the Member’s needs has been agreed upon. *Extraordinary Circumstances. In determining "extraordinary circumstances", Anthem Blue Cross may take into account whether or not the Member’s condition was severe enough to prevent him or her from notifying Anthem Blue Cross, or whether or not someone from the Member’s family was available to notify Anthem Blue Cross for the Member. The Member may have to prove that such "extraordinary circumstances" were present at the time of the Emergency.
Sample 1
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Related to Care Coordination Reviews

  • Care Coordination The Parties’ subcontract shall require that the Enrollee’s CP Care Coordinator provide ongoing care coordination support to the Enrollee in coordination with the Enrollee’s PCP and other providers as set forth in Section 2.6.

  • Donor Coordination Throughout the multi-year development of the Compact, MCC and the Government have engaged in an inclusive process that included consultations with the United States Government, Nepali communities and key private sector actors, non-government actors, and other donors as well as multilateral organizations. In particular, MCC worked closely with the World Bank and the Asian Development Bank in reviewing and agreeing on various power sector reforms required in Nepal for future programming by the two banks. MCC also consulted frequently with the United Kingdom’s Department for International Development (“DFID”) during its preparation of a political economy analysis of power sector reform.

  • Program Coordinator An individual designated by the program director to assist the program director in managing Match activities.

  • Project Coordination The Engineer shall coordinate all subconsultant activity to include quality and consistency of deliverables and administration of the invoices and monthly progress reports. The Engineer shall coordinate with necessary local entities.

  • Cooperation and Coordination The Parties acknowledge and agree that it is their mutual objective and intent to minimize, to the extent feasible and legal, taxes payable with respect to their collaborative efforts under this Agreement and that they shall use all commercially reasonable efforts to cooperate and coordinate with each other to achieve such objective.

  • Project Management and Coordination The Engineer shall coordinate all subconsultant activity to include quality of and consistency of work and administration of the invoices and monthly progress reports. The Engineer shall coordinate with necessary local entities.

  • Operation and Coordination The ISO shall direct the operation of, and coordinate the maintenance scheduling of, certain facilities of the NYS Power System, including coordination with control centers maintained by the Transmission Owners in accordance with the Reliability Rules, as follows:

  • Order Coordination and Order Coordination-Time Specific 2.1.9.1 “Order Coordination” (OC) allows BellSouth and Global Connection to coordinate the installation of the SL2 Loops, Unbundled Digital Loops (UDL) and other Loops where OC may be purchased as an option, to Global Connection’s facilities to limit end user service outage. OC is available when the Loop is provisioned over an existing circuit that is currently providing service to the end user. OC for physical conversions will be scheduled at BellSouth’s discretion during normal working hours on the committed due date. OC shall be provided in accordance with the chart set forth below.

  • Project Coordinator 3. Within 14 days of the effective date of this Consent Agreement, DTSC and Respondent shall each designate a Project Coordinator and shall notify each other in writing of the Project Coordinator selected. Each Project Coordinator shall be responsible for overseeing the implementation of this Consent Agreement and for designating a person to act in his/her absence. All communications between Respondent and DTSC, and all documents, report approvals, and other correspondence concerning the activities performed pursuant to this Consent Agreement shall be directed through the Project Coordinators. Each party may change its Project Coordinator with at least seven days prior written notice. WORK TO BE PERFORMED

  • Utilization Review We review health services to determine whether the services are or were Medically Necessary or experimental or investigational ("Medically Necessary"). This process is called Utilization Review. Utilization Review includes all review activities, whether they take place prior to the service being performed (Preauthorization); when the service is being performed (concurrent); or after the service is performed (retrospective). If You have any questions about the Utilization Review process, please call the number on Your ID card. The toll-free telephone number is available at least 40 hours a week with an after-hours answering machine. All determinations that services are not Medically Necessary will be made by: 1) licensed Physicians; or 2) licensed, certified, registered or credentialed health care professionals who are in the same profession and same or similar specialty as the Provider who typically manages Your medical condition or disease or provides the health care service under review. We do not compensate or provide financial incentives to Our employees or reviewers for determining that services are not Medically Necessary. We have developed guidelines and protocols to assist Us in this process. Specific guidelines and protocols are available for Your review upon request. For more information, call the number on Your ID card or visit Our website at xxx.xxxxxxx.xxx.

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