Common use of Managed Care Process Clause in Contracts

Managed Care Process. The Medical Director and/or SHL's Utilization Review Committee will review proposed services and supplies to be received by an Insured to determine:  If the services are Medically Necessary and/or appropriate.  The appropriateness of the proposed setting.  The required duration of treatment or admission. Following review, SHL will complete the Prior Authorization written notification and send a copy to the Provider and the Insured. This form will specify approved services and supplies. Prior Authorization is not a guarantee of payment for Covered Services. The final decision as to whether any care should be received is between the Insured and the Provider. If SHL denies a request by an Insured and/or Provider for Prior Authorization of a service, the Insured or his Authorized Representative may appeal the denial to the Grievance Review Committee (see the Appeals Procedures Section).

Managed Care Process. The Medical Director and/or SHL's Utilization Review Committee will review proposed services and supplies to be received by an Insured to determine:  If the services are Medically Necessary and/or appropriate.  The appropriateness of the proposed setting.  The required duration of treatment or admission. Following review, SHL will complete the Prior Authorization written notification and send a copy to the Provider and the Insured. This The Prior Authorization form will specify approved services Covered Services and supplies. Prior Authorization is not a guarantee of payment for Covered Services. The final decision as to whether any care should be received is between the Insured and the Provider. If SHL denies a request by an Insured and/or Provider for Prior Authorization of a serviceservice or supply, the Insured or his Authorized Representative Provider may appeal the denial to the Grievance Review Committee (see the Appeals Procedures SectionSection herein).

Managed Care Process. The Medical Director and/or SHL's Utilization Review Committee will review proposed services and supplies to be received by an Insured to determine:  If the services are Medically Necessary and/or appropriate.  The appropriateness of the proposed setting.  The required duration of treatment or admission. Following review, SHL will complete the Prior Authorization written notification form and send a copy to the Provider and the Insured. This The Prior Authorization form will specify approved services Covered Services and supplies. Prior Authorization is not a guarantee of payment for Covered Services. The final decision as to whether any care should be received is between the Insured and the Provider. If SHL denies a request by an Insured and/or Provider for Prior Authorization of a serviceservice or supply, the Insured or his Authorized Representative Provider may appeal the denial to the Grievance Review Committee (see the Appeals Procedures SectionSection herein).