Independent Medical Review definition

Independent Medical Review means an independent evaluation of the medical or chiropractic care of a Member that must include a physical examination of the Member unless he is deceased, and a personal review of all x-rays and reports by a certified Physician or Chiropractor who is formally educated in the applicable medical field.
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Independent Medical Review means an independent evaluation of the medical or chiropractic care of an Insured that must include a physical examination of the Insured unless he is deceased, and a personal review of all x-rays and reports by a certified Physician or Chiropractor who is formally educated in the applicable medical field.
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Independent Medical Review means the analysis of the Treatment by a clinical reviewer of a URAC (formerly known as the Utilization Review Accreditation Commission) accredited independent review organization, who is a board certified physician in the same medical specialty or subspecialty of the underlying Loss, and both external and independent to the Plan and the Administrator.
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Examples of Independent Medical Review in a sentence

  • You may also be eligible for an Independent Medical Review (IMR).

  • This style is directly linked to the SQL database storage system.

  • Denial of Experimental procedures or Investigational services is subject to Independent Medical Review (please refer to the "Independent Medical Review of Investigational or Experimental Therapies" portion of the "Specific Provisions" section for more information).

  • Independent Medical Reviews (IMR)If care that is requested for you is denied, delayed or modified by Sharp Health Plan or a Plan Medical Group, you may be eligible for an Independent Medical Review (IMR).

  • A written reconsideration decision will be provided; and• If you still remain dissatisfied with the reconsideration decision following review by Health Net, you may request an independent review or go through the binding arbitration remedy set forth in the "Independent Medical Review of Grievances Involving a Disputed Health Care Service" and "Binding Arbitration" provisions of the "General Provisions" section of this EOC.

  • If the Member is dissatisfied with the findings of an Independent Medical Review, the Member shall have the right to have the dispute submitted to binding arbitration before an arbiter under the commercial arbitration rules applied by the American Arbitration Association.

  • The Independent Medical Review will include a physical exam of the Member and a personal review of all x-rays and reports made by the primary treating Physician or Chiropractor.

  • The Department and the Independent Medical Review Organization shall maintain the confidentiality of all documents found by the Commissioner to be proprietary information.

  • The department’s Internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.There is no application or processing fee of any kind associated with the Independent Medical Review process.You may file a grievance with the DMHC if Cigna Dental has not completed the complaint or appeal process described above within 30 days of receiving your grievance.

  • The Member may also be eligible for an Independent Medical Review (IMR).


More Definitions of Independent Medical Review

Independent Medical Review means a process to complete an initial screening of a Covered Person’s grievance.
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Independent Medical Review means a review of the Medical Necessity of the disputed procedure. It does not consider coverage or contract interpretation questions, such as:
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Related to Independent Medical Review

  • Medical Review Officer (MRO) means a licensed physician responsible for receiving and reviewing laboratory results generated by the school district’s drug testing program and for evaluating medical explanations for certain drug tests.

  • Medical Review Officer (MRO means a licensed M.D. or D.O. with knowledge of drug abuse disorders, employed or used by the City to review drug results in accordance with this procedure.

  • Clinical review criteria means the written screening procedures, decision abstracts, clinical protocols, and practice guidelines used by a health carrier to determine the necessity and appropriateness of health care services.

  • Independent testing laboratory means an independent organization, accepted by the Contracting Officer, engaged to perform specific inspections or tests of the work, either at the site or elsewhere, and report the results of these inspections or tests.

  • Independent educational evaluation means an evaluation conducted by a qualified examiner who is not employed by the public agency responsible for the education of the child in question.

  • independent review committee means the independent review committee of the investment fund established under National Instrument 81-107 Independent Review Committee for Investment Funds;

  • Medical Advisory Committee means the Medical Advisory Committee established by the Board as required by the Public Hospitals Act;

  • Medical Board means the North Carolina Medical Board.

  • District Evaluation Advisory Committee means a group created to oversee and guide the planning and implementation of the Board of Education's evaluation policies and procedures as set forth in N.J.A.C. 6A:10-2.3.

  • Peer-reviewed medical literature means a scientific study published only after having been critically

  • Independent review organization means an entity that is accredited to conduct independent external reviews of adverse benefit determinations.

  • Independent Evaluator A person empowered, pursuant to Section 23.5 (Failure to Reach Agreement) and Section 23.10 (Dispute) of this Agreement, to resolve disputes due to failure of the Parties to agree on a Performance Standards Revision Document.

  • Medical Executive Committee or “MEC” means the Executive Committee of the Medical Staff.

  • Qualified medical provider means the same as that term is defined in Section 26-61a-102.

  • Independent Inspector means a qualified third-party petroleum inspection contractor acceptable to both parties providing petroleum sampling, measurement and other services before, during and after a Delivery.

  • Supervisory Review means ongoing clinical case reviews in accordance with procedures developed by ADMINISTRATOR, to determine the appropriateness of Diagnosis and treatment and to monitor compliance to the minimum ADMINISTRATOR and Medi-Cal charting standards. Supervisory review is conducted by the program/clinic director or designee.

  • OPSI Advisory Committee means the committee established under Tariff, Attachment M, section III.G.

  • Technical Advisory Committee means the external committee to be established and appointed by the Steering Committee to provide technical input for decisions to be taken by the Steering Committee; and

  • Independent Manager shall refer to a member of the Board that meets the standards of an “independent director” set forth in NASDAQ Marketplace Rule 4200(a)(15) (on any successor rule) with respect the Company, the Administrator and their respective affiliates. In the event a Special Committee is formed, the term “Independent Manager” shall, as the context requires, refer generically to each Independent Manager.

  • Architectural Review Committee or “ARC” shall mean the architectural review committee established by the Organization to review plans submitted to the Organization for architectural review.

  • Medical cannabis dispensary means an organization issued a

  • Qualified Medical Practitioner means any person legally authorized by the Government with jurisdiction in the geographical area of his or her practice to render medical or surgical service, but excluding a qualified medical practitioner who is the Insured Person or an Immediate Family Member of the Insured Person.

  • Drug utilization review means an evaluation of a prescription drug order and patient records for

  • MEDICAL STAFF LEADER means any Medical Staff Officer, department chair, section chief, and committee chair.

  • Independent Verification means that an evaluation is undertaken and reported by an individual or body whose organisation, systems and procedures conform to ISO Guide 65:1996 (EN 45011:1998) General requirements for bodies operating product certification systems (as amended form time to time) or equivalent, and who is accredited to audit against forest management standards by a body whose organisation, systems and procedures conform to ISO 17011: 2004 General Requirements for Providing Assessment and Accreditation of Conformity Assessment Bodies (as amended from time to time) or equivalent.

  • Evaluation Team means the team appointed by the City; “Information Meeting” has the meaning set out in section 2.2;