{"component": "definition", "props": {"groups": [{"size": 137, "snippet": "means utilization review conducted during", "samples": [{"hash": "fWzRFtgkuao", "uri": "https://lawfilesext.leg.wa.gov/biennium/2007-08/Pdf/Bills/House%20Bills/2660.pdf", "label": "lawfilesext.leg.wa.gov", "score": 18.4224300385, "published": false}, {"hash": "eMyNqoDCjnm", "uri": "https://app.leg.wa.gov/documents/billdocs/1995-96/Pdf/Bills/House%20Bills/2617.pdf", "label": "app.leg.wa.gov", "score": 17.7812709808, "published": false}, {"hash": "4HR4CPJvM7u", "uri": "https://lawfilesext.leg.wa.gov/biennium/2007-08/Pdf/Bills/House%20Bills/1569-S2.pdf?q=20200321004106", "label": "lawfilesext.leg.wa.gov", "score": 12.2320327759, "published": false}], "snippet_links": [{"key": "utilization-review", "type": "definition", "offset": [6, 24]}], "hash": "90e9fec685324a171436deea29c632ff", "id": 1}, {"size": 82, "snippet": "means utilization review conducted during a patient's hospital stay or course of treatment.", "samples": [{"hash": "ftRYavZdEAO", "uri": "https://lawfilesext.leg.wa.gov/biennium/2019-20/Docx/Bills/Senate%20Bills/5805-S.docx", "label": "lawfilesext.leg.wa.gov", "score": 20.0516815186, "published": false}, {"hash": "6std5KuCrm4", "uri": "https://lawfilesext.leg.wa.gov/biennium/2019-20/Docx/Bills/House%20Bills/1870-S.docx", "label": "lawfilesext.leg.wa.gov", "score": 19.6448764801, "published": false}, {"hash": "ac4w0nZAUDl", "uri": "https://lawfilesext.leg.wa.gov/biennium/2019-20/Docx/Bills/House%20Passed%20Legislature/1065-S2.PL.docx", "label": "lawfilesext.leg.wa.gov", "score": 19.568901062, "published": false}], "snippet_links": [{"key": "utilization-review", "type": "definition", "offset": [6, 24]}, {"key": "hospital-stay", "type": "definition", "offset": [54, 67]}, {"key": "course-of-treatment", "type": "clause", "offset": [71, 90]}], "hash": "c0a93b39c6110af448c6b56a9d3afb40", "id": 2}, {"size": 38, "snippet": "means utilization review conducted during a patient\u2019s stay or course of treatment in a facility, the office of a health care professional or other inpatient or outpatient health care setting.", "samples": [{"hash": "rWGAueWRl7", "uri": "https://content.naic.org/sites/default/files/MO073.pdf", "label": "content.naic.org", "score": 8.4195756912, "published": false}, {"hash": "4QqZd0PW0Wp", "uri": "https://content.naic.org/sites/default/files/MO072.pdf", "label": "content.naic.org", "score": 8.4195756912, "published": false}, {"hash": "8UQ9YZuTMvZ", "uri": "https://content.naic.org/sites/default/files/inline-files/MDL-073.pdf", "label": "content.naic.org", "score": 7.6557154655, "published": false}], "snippet_links": [{"key": "utilization-review", "type": "definition", "offset": [6, 24]}, {"key": "course-of-treatment", "type": "clause", "offset": [62, 81]}, {"key": "a-facility", "type": "definition", "offset": [85, 95]}, {"key": "the-office", "type": "clause", "offset": [97, 107]}, {"key": "health-care-professional", "type": "definition", "offset": [113, 137]}, {"key": "health-care-setting", "type": "definition", "offset": [171, 190]}], "hash": "d0eb67b9e1b1e4f4379f715bbca9c591", "id": 3}, {"size": 33, "snippet": "means utilization review conducted during a patient\u2019s hospital stay or course of treatment.", "samples": [{"hash": "7Cgvt9dDxTl", "uri": "https://www.maine.gov/pfr/insurance/sites/maine.gov.pfr.insurance/files/inline-files/rule-850-heatlh-plan-accountability-redlined.pdf", "label": "www.maine.gov", "score": 17.3238277435, "published": false}, {"hash": "6tjray2NpgD", "uri": "https://www.legislature.mi.gov/documents/2015-2016/billenrolled/house/pdf/2015-HNB-4933.PDF", "label": "www.legislature.mi.gov", "score": 11.3173427582, "published": false}, {"hash": "7lzTqTp7QTZ", "uri": "http://laws.flrules.org/files/Ch_1997-159.pdf", "label": "laws.flrules.org", "score": 10.0479125977, "published": false}], "snippet_links": [{"key": "utilization-review", "type": "definition", "offset": [6, 24]}, {"key": "hospital-stay", "type": "definition", "offset": [54, 67]}, {"key": "course-of-treatment", "type": "clause", "offset": [71, 90]}], "hash": "aa65422bf8344c7145f323aeac7b6069", "id": 4}, {"size": 31, "snippet": "means utilization review conducted during an inpatient stay.", "samples": [{"hash": "9mYie6uJAv5", "uri": "https://dir.ca.gov/dwc/DWCPropRegs/2024/Utilization-Review/2nd-15-Day-Comment-Period/Text-of-Regulations-Accessible.docx", "label": "dir.ca.gov", "score": 20.1325569153, "published": false}, {"hash": "e1xOzWXOdyL", "uri": "https://www.dir.ca.gov/dwc/DWCPropRegs/2024/Utilization-Review/15-Day-Comment-Period/Text-of-Regulations-Accessible.docx", "label": "www.dir.ca.gov", "score": 20.0108776093, "published": false}, {"hash": "hPmxLwynLl8", "uri": "https://encompasswc.com/wp-content/uploads/2023/06/Encompass-URAC-Accredited-UR-Plan-06012023.pdf", "label": "encompasswc.com", "score": 18.4787998199, "published": false}], "snippet_links": [{"key": "utilization-review", "type": "definition", "offset": [6, 24]}, {"key": "inpatient-stay", "type": "clause", "offset": [45, 59]}], "hash": "6c605a80ff49a0f037e93bf23be64c34", "id": 5}, {"size": 31, "snippet": "means a function performed by EGID or its designee that determines and updates medical necessity for continued inpatient hospitalization.", "samples": [{"hash": "jtGEIcO5aa6", "uri": "/contracts/jtGEIcO5aa6#concurrent-review", "label": "Network Provider Physician Contract", "score": 31.7222690582, "published": true}, {"hash": "bnJUdkwNMrL", "uri": "/contracts/bnJUdkwNMrL#concurrent-review", "label": "Network Provider Contract", "score": 31.7222690582, "published": true}, {"hash": "aXWYXfJBrJf", "uri": "/contracts/aXWYXfJBrJf#concurrent-review", "label": "Network Provider Nurse Practitioner Contract", "score": 31.7222690582, "published": true}], "snippet_links": [{"key": "performed-by", "type": "clause", "offset": [17, 29]}, {"key": "medical-necessity", "type": "definition", "offset": [79, 96]}, {"key": "inpatient-hospitalization", "type": "definition", "offset": [111, 136]}], "hash": "9a389cd606b80023eb052e3e4563383e", "id": 6}, {"size": 23, "snippet": "means utilization review conducted during a covered person's course of treatment or hospital stay;", "samples": [{"hash": "9LXtsl1EJQp", "uri": "https://statecodesfiles.justia.com/kentucky/2022/chapter-304/subtitle-304-17a/section-304-17a-600-4/section-304-17a-600-4.pdf?ts=1668015398", "label": "statecodesfiles.justia.com", "score": 18.5167694092, "published": false}, {"hash": "cflY5RdNbew", "uri": "https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=53230", "label": "apps.legislature.ky.gov", "score": 16.0386714935, "published": false}, {"hash": "5VG3oCFCCwH", "uri": "https://apps.legislature.ky.gov/recorddocuments/bill/24RS/sb270/orig_bill.pdf", "label": "apps.legislature.ky.gov", "score": 15.7757968903, "published": false}], "snippet_links": [{"key": "utilization-review", "type": "definition", "offset": [6, 24]}, {"key": "covered-person", "type": "clause", "offset": [44, 58]}, {"key": "course-of-treatment", "type": "clause", "offset": [61, 80]}, {"key": "hospital-stay", "type": "definition", "offset": [84, 97]}], "hash": "36f58d782853cc8b3a47ae3571aeb071", "id": 7}, {"size": 17, "snippet": "means the process by which applications competing to provide services in the same planning area are reviewed simultaneously by the department.", "samples": [{"hash": "kgssosRypMY", "uri": "https://lawfilesext.leg.wa.gov/law/wsrpdf/2024/18/24-18-006.pdf", "label": "lawfilesext.leg.wa.gov", "score": 19.6871185303, "published": false}, {"hash": "8Mks1JQL3yy", "uri": "https://lawfilesext.leg.wa.gov/law/wsr/2024/18/24-18PERM.pdf", "label": "lawfilesext.leg.wa.gov", "score": 19.3388309479, "published": false}, {"hash": "6q4r2L4pHD0", "uri": "https://doh.wa.gov/sites/default/files/2024-02/FMCNA-PublicComment20240106.pdf", "label": "doh.wa.gov", "score": 18.66664505, "published": false}], "snippet_links": [{"key": "the-process", "type": "clause", "offset": [6, 17]}, {"key": "services-in-the", "type": "clause", "offset": [61, 76]}, {"key": "planning-area", "type": "definition", "offset": [82, 95]}, {"key": "by-the-department", "type": "clause", "offset": [124, 141]}], "hash": "ec327514781ec751da5b9e2eb98b9022", "id": 8}, {"size": 16, "snippet": "means a utilization review conducted during a patient's stay or course of", "samples": [{"hash": "iWY3tIMVYCX", "uri": "https://archive.legmt.gov/content/Sessions/69th/Contractor_index/CH0274.pdf", "label": "archive.legmt.gov", "score": 19.3634662628, "published": false}, {"hash": "1VWg1BMcPCd", "uri": "https://archive.legmt.gov/bills/2019/HB0599//HB0555_4.pdf", "label": "archive.legmt.gov", "score": 11.1069831848, "published": false}, {"hash": "cLKuXDxJ3vK", "uri": "https://archive.legmt.gov/bills/2017/hb0199/HB0137_2.pdf", "label": "archive.legmt.gov", "score": 8.9496135712, "published": false}], "snippet_links": [{"key": "utilization-review", "type": "definition", "offset": [8, 26]}], "hash": "4dc15002380f4534e8052787bb94ddab", "id": 9}, {"size": 14, "snippet": "means utilization review", "samples": [{"hash": "gRbicY9lFim", "uri": "https://www.flsenate.gov/Session/Bill/1998/297/BillText/c1/PDF", "label": "www.flsenate.gov", "score": 17.761177063, "published": false}, {"hash": "2tVgwaMBjWH", "uri": "https://lawfilesext.leg.wa.gov/biennium/2001-02/Pdf/Bills/House%20Bills/1633-S.pdf", "label": "lawfilesext.leg.wa.gov", "score": 10.8713207245, "published": false}, {"hash": "hI6bmzMCJi", "uri": "https://apps.leg.wa.gov/documents/billdocs/2001-02/Pdf/Bills/House%20Bills/1633.pdf", "label": "apps.leg.wa.gov", "score": 9.4531145096, "published": false}], "snippet_links": [{"key": "utilization-review", "type": "definition", "offset": [6, 24]}], "hash": "f10f5e8a903fbb49e933cab6af98b66e", "id": 10}], "next_curs": "Cl4SWGoVc35sYXdpbnNpZGVyY29udHJhY3RzcjoLEhpEZWZpbml0aW9uU25pcHBldEdyb3VwX3Y1NiIaY29uY3VycmVudC1yZXZpZXcjMDAwMDAwMGEMogECZW4YACAA", "definition": {"size": 592, "snippet": "means utilization review conducted during", "title": "Concurrent review", "id": "concurrent-review", "examples": ["<strong>Concurrent review</strong> shall be performed during admission to a hospital.", "<strong>Concurrent review</strong> is conducted both telephonically and via onsite review at selected facilities.", "<strong>Concurrent review</strong> processes address the appropriateness of an admission, continued stay setting and level of care as well as identify and prevent delays in care, clinical coverage decisions and discharge planning.", "<strong>Concurrent review</strong> is the responsibility of the facility, not the Member.", "<strong>Concurrent review</strong>; for inpatient stays of any kind, the Insurers will pre-approve and issue a GOP for a limited number of days of confinement.", "The <strong>Concurrent Review</strong> Program includes <strong>Concurrent Review</strong> and Discharge Planning <strong>Concurrent Review</strong> Concurrent review is conducted by experienced Keystone Health Plan Central registered nurses and board- certified Physicians to evaluate and monitor the quality and appropriateness of initial and ongoing medical care provided in Inpatient settings (Acute Care Hospitals, Skilled Nursing Facilities, Inpatient Rehabilitation Hospitals, and Long-Term Acute Care Hospitals).", "<strong>Concurrent review</strong> of inpatient admissions at participating and non-participating facilities is performed weekdays to determine the need for continued health care services.", "<strong>Concurrent review</strong> with daily interviews such as performed during the validation would render the collection more accurate, but was considered not feasible for 1000 patients.", "<strong>Concurrent review</strong> includes an assessment of the member\u2019s progress towards recovery and readiness for discharge while the member is hospitalized or in a nursing facility; and may involve an assessment of the medical necessity of tests or procedures while the member is hospitalized or in a nursing facility.", "<strong>Concurrent review</strong> means MVP\u2019s review of a request to extend a course of treatment beyond the period of time or number of treatments approved under paragraph 2, to determine whether such services continue to be Medically Necessary Covered Services."], "related": [["concurrent-enrollment", "Concurrent enrollment", "Concurrent enrollment"], ["concurrent-user", "Concurrent User", "Concurrent User"], ["application-review-start-date", "Application Review Start Date", "Application Review Start Date"], ["current-report", "Current Report", "Current Report"], ["due-diligence-review", "Due Diligence Review", "Due Diligence Review"]], "related_snippets": [], "updated": "2025-07-24T04:27:56+00:00"}, "json": true, "cursor": ""}}