Adverse decision definition

Adverse decision means any decision by a review agent not to certify an admission,
Adverse decision means a decision reducing,
Adverse decision means a utilization review determination by the utilization review entity that a

Examples of Adverse decision in a sentence

  • If staff are able to answer an unattended ringing telephone they will do so and leave a message for the person concerned.

  • For purposes of this part: Adverse decision means an administrative decision made by an officer, employee, or committee of an agency that is adverse to a participant.

  • Such Adverse decision shall be held in abeyance until the applicant has exercised or been deemed to have waived their procedural due process rights, if any, under the Medical Staff Bylaws.

  • The fact that the Adverse decision is held in abeyance shall not be deemed to confer Privileges when none existed before.

  • The fact that the Adverse decision is held in abeyance shall not be deemed to confer Medical Staff appointment and/or Privileges where none existed before.


More Definitions of Adverse decision

Adverse decision means a utilization review determination that:
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 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 denial in whole or in part of a pre- determination or a post-service claim and for which You are financially responsible or, for a pre-determination, for which You would be financially responsible, if You obtained the service.
Adverse decision means a utilization review determination by a Private Review Agent, a carrier, or a Health Care Provider acting on behalf of a carrier that: (1) a proposed or delivered Health Care Service covered under the Enrollee’s contract is or was not medically necessary, appropriate, or efficient; and (2) may result in non-coverage of Health Care Service. An Adverse Decision does not include a decision concerning an Enrollee’s status.
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 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.