External review organization definition

External review organization means an entity that conducts independent external reviews of adverse decisions pursuant to a contract with the commissioner. Such entity shall be a nationally accredited external review organization which utilizes health care providers actively engaged in the practice of their profession in the state of Kansas who are qualified and credentialed with respect to the health care service review. In the event the entity has no Kansas providers available who are qualified and credentialed with respect to the review of any case, the external review organization shall have the discretion to employ health care providers who actively engage in such health care provider's practice outside the state of Kansas.
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External review organization means an entity that conducts independent external reviews of adverse determinations and final adverse determinations;
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External review organization means an entity that conducts independent External Reviews of Adverse Decisions pursuant to a contract with the Kansas Insurance Department.
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Examples of External review organization in a sentence

  • External review organization" means an entity that conducts independent external reviews of adverse decisions pursuant to a contract with the commissioner.

  • External review organization reporting and record retention requirements.

  • External review organization means an organization that has contracted with a hospital to provide external review of PCI cases and that maintains appropriate oversight of each external reviewer who evaluates PCI cases for a hospital.


More Definitions of External review organization

External review organization means an entity that conducts independent external reviews of adverse determinations and final adverse determinations and whose accreditation or certification has been reviewed and approved by the Department of Insurance.
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External review organization means an organization that has contracted with a hospital to provide external review of PCI cases and that maintains appropriate oversight of each external reviewer who evaluates PCI cases for a hospital. The term includes an
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External review organization means an entity that conducts independent external
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External review organization means an entity that conducts independent external reviews of adverse determinations and final adverse determinations of a health carrier regarding medical necessity, appropriateness, healthcare setting, level of care or effectiveness of a healthcare service or treatment, or healthcare provider compensation;
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External review organization means an organization that has contracted with a hospital to provide external review of PCI cases and that maintains appropriate oversight of each external reviewer who evaluates PCI cases for a hospital. The term includes an organization that has been approved by the Commission, as provided in Section .08D, that uses a Commission- approved blinded system for external review.
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Related to External review organization

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Professional employer organization means an employee leasing

  • Health care organization ’ means any person or en-

  • Nonprofit organization means a university or other institution of higher education or an organization of the type described in section 501(c)(3) of the Internal Revenue Code of 1954 (26 U.S.C. 501(c) and exempt from taxation under section 501(a) of the Internal Revenue Code (25 U.S.C. 501(a)) or any nonprofit scientific or educational organization qualified under a state nonprofit organization statute.