Appropriate and medically necessary definition

Appropriate and medically necessary means, regarding drug prescribing, dispensing, and patient usage, that it is in conformity with the criteria and standards developed in accordance with this part.
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Appropriate and medically necessary means the standard for health care services as determined by
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Appropriate and medically necessary means the standard for health care services as determined by physicians and health care providers in accordance with the prevailing practices and standards of the medical profession and community.
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Examples of Appropriate and medically necessary in a sentence

  • Appropriate and medically necessary nonresidential and residential treatment services, including placements for youth needing substance abuse treatment services and children with serious emotional disturbances.

  • Appropriate and medically necessary nonresidential and residential services for children within the child mental health deaf and hard of hearing target population.

  • All SUD Waiver services covered in this chapter are subject to a determination of medical necessity defined as services and supplies that are: • Appropriate and medically necessary for the symptoms, diagnosis or treatment of an illness; • Provided for the diagnosis or direct care of an illness; • Within the standards of good practice; • Not primarily for the convenience of the plan member or provider; and • The most appropriate level of care that can be safely provided.

  • Appropriate and medically necessary nonresidential and residential treatment services, including placements for sexually aggressive youth.

  • Appropriate and medically necessary residential and nonresidential services for deaf children.

  • Appropriate and medically necessary residential and nonresidential treatment services including placements for youths needing substance abuse treatment services and children with serious emotional disturbances.

  • Appropriate and medically necessary residential and nonresidential treatment services including placements for sexually aggressive youth.

  • Medical necessity is defined as services that are: • Appropriate and medically necessary for the symptoms, diagnosis, or treatment of an illness;• Provided for the diagnosis or direct care of an illness;• Within the standards of good practice;• Not primarily for the convenience of the plan member or provider; and• The most appropriate level of care that can be safely provided.

  • The Medical Management Program is designed to assist VCHCP contracted physicians, providers, and hospitals in ensuring that medical services are: • Covered under the member's health plan benefits • Appropriate and medically necessary.

  • The Medical Care Solutions Program is designed to assist Blue Shield contracted physicians, providers, and hospitals in ensuring that medical services are:  Covered under the member’s health plan benefits;  Appropriate and medically necessary and that such determination are made by qualified licensed health care professionals.


More Definitions of Appropriate and medically necessary

Appropriate and medically necessary means the standard
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Appropriate and medically necessary means the standard for health care services as determined by physicians and health care providers in accordance with Section 20.1 of Title 76 of the Oklahoma Statutes;
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Appropriate and medically necessary means the standard for
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Appropriate and medically necessary means the standard for health care services as
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Appropriate and medically necessary means the recognized standard of acceptable health care services as determined by healthcare providers in accordance with the prevailing practices and standards of the medical profession and community.
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Appropriate and medically necessary means the standard for health care services as determined by health care providers in accordance with generally accepted standards of health care practice.
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Related to Appropriate and medically necessary

  • Medically Necessary means a service which is appropriate and consistent with the treatment of the condition in accordance with accepted standards of community practice.

  • Medically necessary care means care that is (1) appropriate and consistent with and essential for the prevention, diagnosis, or treatment of a Patient’s condition; (2) the most appropriate supply or level of service for the Patient’s condition that can be provided safely; (3) not provided primarily

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Medically Appropriate means services and medical supplies required for prevention, diagnosis, or treatment of a physical or behavioral health condition or injuries that are:

  • Emergency medical technician means a person who is either an EMT-I, EMT-II, or EMT-P (paramedic), and possesses a valid certificate or license in accordance with the standards of Division 2.5 (commencing with Section 1797) of the Health and Safety Code.

  • Qualified medical provider means the same as that term is defined in Section 26-61a-102.

  • Practice of medicine or osteopathic medicine means the prevention, diagnosis and treatment of

  • Emergency medical care provider means an individual who has been trained to provide emergency and nonemergency medical care at the first responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist or other certification levels recognized by the department before 1984 and who has been issued a certificate by the department.

  • Emergency Medical Technician (EMT means: an individual licensed with cognitive knowledge and a scope of practice that corresponds to that level in the National EMS Education Standards and National EMS Scope of Practice Model.

  • Authorized medical physicist means an individual who:

  • Emergency medical services personnel means that term as defined in section 20904 of the public health code, 1978 PA 368, MCL 333.20904.

  • Home health aide services means the personal care and maintenance activities provided to individuals for the purpose of promoting normal standards of health and hygiene.

  • Emergency medical services or “EMS” means an integrated medical care delivery system to provide emergency and nonemergency medical care at the scene or during out-of-hospital patient transportation in an ambulance.

  • Emergency medical care means such medical procedures as:

  • Urgently Needed Services means Covered Services needed to prevent a serious deterioration in a Member’s health. While not as immediate as Emergency Services, these services cannot be delayed until the Member can see a Plan Provider.

  • Primary care-giver means a person who assumes the principal role of providing care and attention to a child.

  • Primary care physician or “PCP” means a Plan Provider who has an independent contractor agreement with HPN to assume responsibility for arranging and coordinating the delivery of Covered Services to Members. A Primary Care Physician’s agreement with HPN may terminate. In the event that a Member’s Primary Care Physician’s agreement terminates, the Member will be required to select another Primary Care Physician.

  • Medical Specialist means any medical practitioner who is vocationally registered by the Medical Council under the Health Practitioners Competence Assurance Act 2003 in one of the approved branches of medicine and who is employed in either that branch of medicine or in a similar capacity with minimal oversight.

  • Behavioral health services means mental health services as

  • Pharmacist services means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy.

  • Chinese Medicine Practitioner means a Chinese medicine practitioner who is duly registered with the Chinese Medicine Council of Hong Kong pursuant to the Chinese Medicine Ordinance (Cap. 549) of the laws of Hong Kong, but excluding the Insured Person, the Policyholder, an insurance intermediary, an employer, employee, Immediate Family Member or business partner of the Policyholder and/or Insured Person.

  • Practice of chiropractic means the adjustment of the 24 movable vertebrae of the spinal column,

  • Primary caregiver or "caregiver" means a resident of the State

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Home health aide means an individual employed by a home health agency to provide home health services under the direction of a registered nurse or therapist.