Medical Bill Review definition

Medical Bill Review refers to the Contractor’s Medical Management Service pertaining to the reviewing medical bills and pharmacy bills for the proper application of the state of California’s official Workers’ Compensation medical fee schedule in effect during the Term(s) of the Contract.
Sample 1
Medical Bill Review means the review of a health care provider’s bill by the carrier, pursuant to Chapter 440, F.S., and all applicable rules, to ensure proper billing and reporting of services by the health care provider; to identify billing errors and inappropriate utilization, which must be disallowed or reduced; and to determine an accurate and timely reimbursement for services reported to the carrier.
Sample 1

Examples of Medical Bill Review in a sentence

  • Authorizing their vendor business partners (TPAs, Medical Bill Review Vendors, etc.) to report the data directly to PCRBRegardless of who submits the Call to the PCRB, the data submitter must report the standard record layout in its entirety with all data elements populated.

  • Authorizing their vendor business partners (TPAs, Medical Bill Review Vendors, etc.) to report the data directly to DCRBRegardless of who submits the Call to the DCRB, the data submitter must report the standard record layout in its entirety with all data elements populated.

  • IMO provides Case Management, Preauthorization, Medical Bill Review, Industry Care Programs, along with other health care management services.

  • Medical Bill Review – Medical Bill Review and Repricing (“Repricing”) includes reviewing the provider’s documentation to assure it supports the billed charges, reducing the provider’s bills to the amounts allowed under the appropriate state’s workers’ compensation fee schedules.

  • MBR (Medical Bill Review): A review of medical bills using a computerized/expert system, PPO, or provider of the same medical discipline as the provider bills being reviewed.

  • Develop and provide communication materials to provide transparency around the policies and procedures of the Medical Bill Review and Audit Services to NEFEC and Medical Providers.

  • City retains its right to select, approve, or reject the Medical Bill Review vendor(s) and any MPN.

  • Medical Bill Review: Medical bills are reviewed to ensure charges by providers comply with the Workers Compensation Fee Schedule.

  • IMO provides Case Management, Pre-Authorization, Medical Bill Review, Industry Care Programs, along with other health care management services.

  • These are:• Rule 69L-7.730, Florida Administrative Code, titled “Health Care Provider Medical Billing and Reporting Responsibilities”; and• Rule 7.740, Florida Administrative Code, titled “Insurer Authorization and Medical Bill Review Responsibilities”.

Related to Medical Bill 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.

  • Medical evaluation means the process of assessing an individual's health status that includes a medical history and a physical examination of an individual conducted by a licensed medical practitioner operating within the scope of his license.

  • 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.

  • Peer-reviewed medical literature means a published scientific study in a journal or other publication in which original manuscripts have been published only after having been critically reviewed for scientific accuracy, validity and reliability by unbiased independent experts, and that has been determined by the international committee of medical journal editors to have met the uniform requirements for manuscripts submitted to biomedical journals. Peer-reviewed medical literature does not include publications or supplements to publications that are sponsored to a significant extent by a pharmaceutical manufacturing company or health carrier.

  • Medical Specialist means any medical practitioner who is vocationally registered by the Medical Council under the Health Practitioners Competence Assurance Act 2003 in one of the approved branches of medicine and who is employed in either that branch of medicine or in a similar capacity with minimal oversight.

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • 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 examination means the preliminary assessment of a person by an authorized health worker or by a person under the direct supervision of the competent authority, to determine the person’s health status and potential public health risk to others, and may include the scrutiny of health documents, and a physical examination when justified by the circumstances of the individual case;

  • Pharmacy means prescribed drugs and medicines dispensed by a pharmacist and/or travel and allergy vaccines dispensed by a pharmacist or doctor.

  • Pharmacist services means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy.

  • Medical cannabis card means the same as that term is defined in Section 26-61a-102.

  • Medical physicist means a person trained in evaluating the performance of mammography equipment and facility quality assurance programs and who meets the qualifications for a medical physicist set forth in 41.6(3)“c.”

  • 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.

  • Prescription monitoring program means the electronic system within the Department of Health Professions that monitors the dispensing of certain controlled substances.

  • Authorized medical physicist means an individual who:

  • Medical Board means the North Carolina Medical Board.

  • Formulary means a list of covered prescription drugs provided under this plan. The formulary includes generic, preferred brand name, non-preferred brand name, and specialty prescription drugs.

  • Training program means a standardized medication

  • MEDICAL STAFF LEADER means any Medical Staff officer, department chairperson, section chairperson, and committee chair.

  • Medical cannabis means the same as that term is defined in Section 26-61a-102.

  • Medical history means information regarding any:

  • Primary care physician means a physician who is a family

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Clinical evaluation means a systematic and planned process to continuously generate, collect, analyse and assess the clinical data pertaining to a device in order to verify the safety and performance, including clinical benefits, of the device when used as intended by the manufacturer;

  • Medical Staff means all physicians, dentists, oral surgeons, and podiatrists who have been appointed to the Medical Staff by the Board.