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.

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. The Prior Authorization form will specify approved Covered Services and supplies. Prior Authorization is not a guarantee of payment for Covered Services.

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.