External Review definition

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

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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

• This request must be submitted in writing on an External Review Request form within 120 days of receipt of the Adverse Benefit Determination.

• Adverse determinations eligible for External Review set forth in this section are only those relating to Medical Necessity, appropriateness of service, healthcare service, healthcare setting, or level of care or effectiveness of a healthcare service.

• The entire External Review process and any associated medical records are confidential.

• We will send you an External Review Request form at the end of the internal appeal process to tell you about your rights to an external review.

• Requests for an External Review must be made in writing and submitted to OCHA at the address below and should include the signed HIPAA authorization form, authorizing the release of your medical records.

More Definitions of External Review

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 of a non-administrative adverse benefit

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

External Review means a review of an adverse benefit determination by a qualified entity independent of the MCO and State. “External medical review” means a medical necessity review of a denied service request.

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.