Adverse decision definition
Adverse decision means a utilization review determination by the utilization review entity that a
Adverse decision means a decision reducing,
Adverse decision means any decision by a review agent not to certify an admission,
Examples of Adverse decision in a sentence
For the purpose of this Section, the following terms have the following meanings: • "Adverse decision" is our utilization review determination that a proposed or delivered Covered Health Service which would otherwise be covered under the Policy is not or was not Medically Necessary, appropriate or efficient, and may result in non-coverage of the health care service.
More Definitions of Adverse decision
Adverse decision means a utilization review determination that:
Adverse decision means a decision of the Director to the effect that a person is not a fit and proper person for any purpose under this Act;
Adverse decision means a final order or decision of the court of appeals, the result of which is contrary, in whole or in part, to the result sought in that court by any party seeking review.
Adverse decision means a determination by Private Review Agent, Ameritas Life Insurance Corp., that a dental service is not medically necessary and reimbursement for the service is either denied or reduced.
Adverse decision means a utilization review determination by a third-party administrator, a health insurance plan, an insurer or a health care provider acting on behalf of an insured that a proposed or delivered health care service which would otherwise be covered under an insured's contract is not or was not medically necessary or the health care treatment has been determined to be experimental or investigational and:
Adverse decision means a decision not to grant approval as an accrediting agency, or to suspend or revoke approval as an accrediting agency;
Adverse decision means a decision reducing, restricting, suspending, revoking, denying, or not renewing medical staff membership or clinical privileges.