Clinical Reviewer definition

Clinical Reviewer means the entity individually chosen to resolve disagreements related to a Member's need for LTPC immediately following an Acute Inpatient Hospital Psychiatric Care stay.
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Clinical Reviewer means a medical reviewer, as defined in this section.
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Clinical Reviewer means a physician or other appropriate health care provider who:
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Examples of Clinical Reviewer in a sentence

  • If the request fails to satisfy these criteria or medical policy, the request is referred to a Peer Clinical Reviewer.

  • If the Peer Clinical Reviewer is still unable to certify the service, your provider will be given the option of having the request reviewed by a different Peer Clinical Reviewer.

  • Only the Peer Clinical Reviewer may determine that the proposed services are not medically necessary and appropriate.

  • When the Peer Clinical Reviewer is unable to certify the service, the requesting physician is contacted by telephone for a discussion of the case.

  • This written notice will include:• an explanation of the reason for the decision,• reference of the criteria used in the decision to modify or not certify the request,• the name and phone number of the Peer Clinical Reviewer making the decision to modify or not certify the request,• how to request reconsideration if you or your provider disagree with the decision.

  • This written notice will include: an explanation of the reason for the decision, reference of the criteria used in the decision to modify or not certify the request, the name and phone number of the Peer Clinical Reviewer making the decision to modify or not certify the request, how to request reconsideration if you or your provider disagree with the decision.

  • Only the Peer Clinical Reviewer may determine that the proposed services are not Medically Necessary and appropriate.

  • When the Peer Clinical Reviewer is unable to certify the service, the requesting Physician is contacted by telephone for a discussion of the case.

  • If the Peer Clinical Reviewer is still unable to certify the service, the Member’s provider will be given the option of having the request reviewed by a different Peer Clinical Reviewer.

  • This written notice will include:  an explanation of the reason for the decision,  reference of the criteria used in the decision to modify or not certify the request,  the name and phone number of the Peer Clinical Reviewer making the decision to modify or not certify the request,  how to request reconsideration if the Member or the Member’s provider disagree with the decision.


More Definitions of Clinical Reviewer

Clinical Reviewer means the Division employee designated to the role of determining eligibility for state hospital admissions.
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Clinical Reviewer means a physician or other health care
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Clinical Reviewer means the entity jointly chosen to resolve disagreements related to an OHP Member's need for LTPC immediately following an Acute Inpatient Hospital Psychiatric Care stay.
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Clinical Reviewer means a physician or other health care provider who is assigned to an external review case by a certified independent review organization, consistent with this chapter.
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Clinical Reviewer means an appropriately licensed or certified healthcare professional who has (1) undIRGone formal training in a health care field; (2) holds an associate or higher degree in a health care field, or holds a state license or state certificate in a health care field; and (3) has professional experience in providing direct patient care.
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Related to Clinical Reviewer

  • Clinical review criteria means the written screening procedures, decision abstracts, clinical protocols, and practice guidelines used by a health carrier to determine the necessity and appropriateness of health care services.

  • Medical Review Officer (MRO) means a licensed physician responsible for receiving and reviewing laboratory results generated by the school district’s drug testing program and for evaluating medical explanations for certain drug tests.

  • Clinical evaluation means a systematic and planned process to continuously generate, collect, analyse and assess the clinical data pertaining to a device in order to verify the safety and performance, including clinical benefits, of the device when used as intended by the manufacturer;

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Training program means an NCA-approved Iowa college, the Iowa law enforcement academy or an Iowa hospital approved by the department to conduct emergency medical care training.

  • Independent testing laboratory means an independent organization, accepted by the Contracting Officer, engaged to perform specific inspections or tests of the work, either at the site or elsewhere, and report the results of these inspections or tests.

  • Technical Report means a report prepared and filed in accordance with this Instrument and Form 43-101F1 Technical Report that includes, in summary form, all material scientific and technical information in respect of the subject property as of the effective date of the technical report; and

  • Diagnostic clinical procedures manual means a collection of written procedures that describes each method (and other instructions and precautions) by which the licensee performs diagnostic clinical procedures; where each diagnostic clinical procedure has been approved by the authorized user and includes the radiopharmaceutical, dosage, and route of administration.

  • Reviewer means the actuary engaged to review or repeat the first actuary’s work, and

  • Medical evaluation means the process of assessing an individual's health status that includes a medical history and a physical examination of an individual conducted by a licensed medical practitioner operating within the scope of his license.

  • Drug utilization review means an evaluation of a prescription drug order and patient records for

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • Clinical means having a significant relationship, whether real or potential, direct or indirect, to the actual rendering or outcome of dental care, the practice of dentistry, or the quality of dental care being rendered to a patient;

  • Phase 2 Clinical Trial means a human clinical trial of a product in any country that would satisfy the requirements of 21 C.F.R. 312.21(b) and is intended to explore a variety of doses, dose response, and duration of effect, and to generate initial evidence of clinical safety and activity in a target patient population, or a similar clinical study prescribed by the relevant Regulatory Authorities in a country other than the United States.

  • Medical Records the Study Subjects’ primary medical records kept by the Institution on behalf of the Study Subjects, including, without limitation, treatment entries, x-rays, biopsy reports, ultrasound photographs and other diagnostic images. Zdravotní záznamy: primární zdravotní záznamy Subjektů studie vedené Zdravotnickým zařízením ve vztahu k Subjektu studie, zejména záznamy o poskytnuté péči, zázanym o RTG vyšetřeních, protokoly o provedených biopsiích, snímky z ultrazvukových vyšetření a další snímky diagnostické povahy. Study Data: all records and reports, other than Medical Records, collected or created pursuant to or prepared in connection with the Study including, without limitation, reports (e.g., CRFs, data summaries, interim reports and the final report) required to be delivered to Sponsor pursuant to the Protocol and all records regarding inventories and dispositions of all Investigational Product. Studijní data a údaje: veškeré záznamy, zprávy a protokoly, jež jsou odlišné od Zdravotních záznamů, a které jsou získány, shromážděny či vytvořeny v návaznosti na či připraveny v souvislosti se Studií, zejména zprávy, záznamy a protokoly (např., CRFs, datové přehledy, mezitímní zprávy a protokoly, a závěrečná zpráva), které jsou požadovány, aby byly poskytnuty Zadavateli v souladu s Protokolem a veškerými záznamy ohledně inventurní evidence a nakládání s veškerým množstvím Hodnoceného léčiva.

  • Asset Representations Reviewer means the asset representations reviewer appointed as provided in the Lead Securitization Servicing Agreement.