External Review definition

External Review means an independent review of an Adverse Benefit Determination conducted by an Independent Review Organization.

External Review means a review that is conducted by an independent review entity which meets specified criteria as established in KRS 304.17A-623, 304.17A-625, and 304.17A-627;

External Review means an independent review of an Adverse Benefit Determination conducted by an External Review Organization.

Examples of External Review in a sentence

• External expert▪ Helge Bischoff, Thoracic Clinic, University Hospital Heidelberg, Germany External review of the rapid report▪ Steffen Frese, Clinic for Thoracic Surgery, Lung Hospital Lostau, Germany IQWiG thanks the external expert and external reviewer for their collaboration in the project.

• It has the role to External review of the project which not only evaluate but contribute to the project technical content.

• External review in the form of a site or reverse site visit will be conducted by NSF approximately 12 months after the start of the award and as often as necessary thereafter.

• Recodified as § 284-43-9993.284-43-3210 External review of adverse benefit determinations.

• The three levels of complaint handling Level 3 - External review of complaints and/or complaint handling by organisations Level 2 - Internal review of complaints and/or complaint handling (may include further investigation of issues raised and use of Alternative Dispute Resolution options).

More Definitions of External Review

External Review means a review of a non-administrative adverse benefit

External Review means an independent review of an Adverse Benefit Determination conducted by an Independent Review Organization. External Review is only available for a Final Adverse Benefit Determination based on Medical Necessity, appropriateness, health care setting, level of care, or effectiveness of a Covered Service.

External Review means a review conducted by persons from outside the resource center who represent the specialties that are required to be reviewed.

External Review means a school division-level academic review conducted by an organization or agency at the request of a local school board.

External Review means a process, independent of all affected parties, to determine if a health care service is medically necessary or experimental/ investigational.

External Review means a review by an independent physician as chosen by the Independent Review Organization. “Independent Review Organization” (IRO) means the entity with which the claims administrator has contracted to conduct external reviews for the plan.

External Review means a review of an adverse benefit determination (including a final internal adverse