Clinically Necessary definition

Clinically Necessary means best practices for Behavioral Health needs.
Sample 1
Clinically Necessary means a service or supply that is required to diagnose or treat a Condition and which MMO determines is:
Sample 1

Examples of Clinically Necessary in a sentence

  • To be covered at the In-Network benefit level, services must be Clinically Necessary and provided by a UBH In-Network clinician.

  • To be covered at the Out-of-Network benefit level, services must be Clinically Necessary, which will be determined through Retrospective Review.

  • The Plan attests that it does not limit benefits based on genetic testing when Medically/ Clinically Necessary.

  • The proposal exceeds the requirements of policy CS12 and there is no requirement for any financial contribution.

  • To be covered at the In-Network benefit level, services must be Clinically Necessary and provided by an Optum In-Network clinician.

  • Expenses determined not Clinically Necessary will not be covered.

  • If we determine that the care received was Medically/ Clinically Necessary and provided by an Affiliated Provider, the care will be Covered.

  • A Member has the right to call the Plan to voice a complaint or write to the Plan to file a written complaint about any of the following:Benefits (including services determined to be experimental or investigational or not Medically/ Clinically Necessary).

  • If Out-of-Network inpatient services are not preauthorized, they will be covered after a $200 penalty if they are Clinically Necessary.

  • The Preauthorization Requirement does not apply to Emergency services.2. To be covered at the Out-of-Network benefit level, services must be Clinically Necessary, which will be determined through Retrospective Review.

Related to Clinically 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:

  • Technically Feasible refers solely to technical or operational concerns, rather than economic, space, or site considerations.

  • Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which:

  • Non-surgically implanted prostheses means a replacement body part not surgically implanted.

  • Developmentally appropriate means suitable to the chronological age range and developmental characteristics of a specific group of children.

  • Contractor Commercially Sensitive Information means the information listed in the Contractor Commercial Sensitive Information Annex to the Contract being information notified by the Contractor to the Authority which is acknowledged by the Authority as being commercially sensitive information.

  • Assisted outpatient treatment or "AOT" means the categories of outpatient services ordered by the court under section 468 or 469a. Assisted outpatient treatment may include a case management plan and case management services to provide care coordination under the supervision of a psychiatrist and developed in accordance with person-centered planning under section 712. Assisted outpatient treatment may also include 1 or more of the following categories of services: medication; periodic blood tests or urinalysis to determine compliance with prescribed medications; individual or group therapy; day or partial day programming activities; vocational, educational, or self-help training or activities; assertive community treatment team services; alcohol or substance use disorder treatment and counseling and periodic tests for the presence of alcohol or illegal drugs for an individual with a history of alcohol abuse or substance use disorder; supervision of living arrangements; and any other services within a local or unified services plan developed under this act that are prescribed to treat the individual's mental illness and to assist the individual in living and functioning in the community or to attempt to prevent a relapse or deterioration that may reasonably be predicted to result in suicide, the need for hospitalization, or serious violent behavior. The medical review and direction included in an assisted outpatient treatment plan shall be provided under the supervision of a psychiatrist.

  • 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.

  • External beam radiation therapy means therapeutic irradiation in which the source of radiation is at a distance from the body.

  • Biologically-based mental illness means schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, and panic disorder, as these terms are defined in the most recent edition of the diagnostic and statistical manual of mental disorders published by the American Psychiatric Association.

  • Study means the investigation to be conducted in accordance with the Protocol.

  • Collaborative drug therapy management means participation by an authorized pharmacist and a physician in the management of drug therapy pursuant to a written community practice protocol or a written hospital practice protocol.

  • Elder abuse (OAA) means abuse, neglect, or exploitation of an older individual (elder) including the willful:

  • 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;

  • Medical marijuana product means a product that contains cannabinoids that have been extracted from plant material or the resin therefrom by physical or chemical means and is intended for administration to a licensed patient, including but not limited to concentrates, oils, tinctures, edibles, pills, topical forms, gels, creams, and other derivative forms, except that this term does not include live plant forms.

  • Medical marijuana waste or "waste" means unused,

  • Medical marijuana means marijuana that is grown, processed, dispensed, tested, possessed, or used for a medical purpose.

  • Pre-Licensed Therapist means an individual who has obtained a Master’s Degree in Social Work or Marriage and Family Therapy and is registered with the BBS as an Associate CSW or MFT Intern acquiring hours for licensing. An individual’s registration is subject to regulations adopted by the BBS.

  • Designated chemical dependency specialist means a person

  • Anatomical gift means a donation of all or part of a human body to take effect after the donor's death for the purpose of transplantation, therapy, research, or education.

  • in vitro diagnostic medical device means any medical device which is a reagent, reagent product, calibrator, control material, kit, instrument, apparatus, equipment, software or system, whether used alone or in combination, intended by the manufacturer to be used in vitro for the examination of specimens, including blood and tissue donations, derived from the human body, solely or principally for the purpose of providing information:

  • Socially and economically disadvantaged person means an individual who is a citizen or lawful permanent resident of the United States and who is Black, Hispanic, Native American, Asian, Female; or a member of another group or an individual found to be disadvantaged by the Small Business Administration pursuant to Section 3 of the Small Business Act.

  • Behavioral health treatment means counseling and treatment programs, including applied behavior analysis, that are:

  • Step therapy protocol means a protocol or program that establishes the specific