Medical Coverage Guidelines definition

Medical Coverage Guidelines means BCBSAZ medical, pharmaceutical, dental and administrative criteria that are developed from review of published, peer-reviewed medical, pharmaceutical and dental literature and other relevant information and used to help BCBSAZ determine whether a service, procedure, medical device or drug is eligible for benefits under a member's benefit plan. The Medical Coverage Guidelines also include prescription medication limitations. BCBSAZ periodically reviews and amends the Medical Coverage Guidelines in response to changes and advancements in medical knowledge and scientific study. Benefit determinations are based on the Medical Coverage Guidelines in effect at the time of service. You or your provider can review a specific guideline by going to the "Claims & Benefits" section on www.azblue.com and choosing "Health Benefits and Medical Coverage Guidelines." Specific Guidelines are also available by calling the number for requesting Medical Coverage Guidelines listed in the front of this book.
Sample 1Sample 2Sample 3
Medical Coverage Guidelines means BCBSAZ medical, pharmaceutical, dental and administrative criteria that are developed from review of published, peer-reviewed medical, pharmaceutical and dental literature and other relevant information and used to help BCBSAZ determine whether a service, procedure, medical device or drug is eligible for benefits under a member's benefit plan. The Medical Coverage Guidelines also include
Sample 1

Examples of Medical Coverage Guidelines in a sentence

  • BCBSAZ regularly updates its systems, claim and pricing guidelines and edits, and Medical Coverage Guidelines.

  • Claim Editing Procedures‌ In order to process claims accurately, BCBSAZ uses a computer system to verify benefits, eligibility, claims accuracy and compliance with BCBSAZ coding guidelines and the Medical Coverage Guidelines.

  • Information on how to obtain a copy of the Medical Coverage Guidelines is in the customer service section at the front of this book.

  • Claim Editing Procedures and Pricing Guidelines‌ BCBSAZ uses systems to verify benefits, eligibility, claims accuracy and compliance with BCBSAZ coding and pricing guidelines and the Medical Coverage Guidelines.

  • Claim Editing Procedures and Pricing Guidelines BCBSAZ uses systems to verify benefits, eligibility, claims accuracy and compliance with BCBSAZ coding and pricing guidelines and the Medical Coverage Guidelines.

  • For information on the foreign travel immunizations covered under this benefit, go to the Medical Coverage Guidelines available at www.azblue.com/member, or call BCBSAZ Customer Service at the number listed in the front of this book.

  • Medical Coverage Guidelines (only if indicated by specific OAR/rule)MCGa. Medicare Coverage Guidelines (NCD/LCD only)b.

  • Claim Editing Procedures In order to process claims accurately, BCBSAZ uses a computer system to verify benefits, eligibility, claims accuracy and compliance with BCBSAZ coding guidelines and the Medical Coverage Guidelines.

  • The coding edits reflect Experience Health Medical Coverage Guidelines, benefit plans, and/or other Experience Health policies.

  • These summaries will be logged in the Medical Coverage Guidelines (MCG) Departments Clinical Summary log but not posted on the Molina Intranet for usage.

Related to Medical Coverage Guidelines

  • Individual health insurance coverage means health insurance coverage offered to individuals in the

  • Group health insurance coverage means in connection with a group health plan, health insurance

  • 2%/25% Guidelines has the meaning set forth in Section 13.

  • Health insurance coverage means benefits consisting of medical care (provided directly, through

  • Applicable Guidelines means the policies of the Bank governing the selection and Contract award process as set forth in this RFP.

  • Health insurance carrier or "carrier" means any entity subject to the insurance

  • Environmental Guidelines means the environmental guidelines and occupational health and safety standards of the World Bank Group as in effect on [Bid Date].

  • Health insurance plan means any health insurance policy or health benefit plan offered by a health insurer or a subcontractor of a health insurer, as well as Medicaid and any other public health care assistance program offered or administered by the State or by any subdivision or instrumentality of the State. The term includes vision care plans but does not include policies or plans providing coverage for a specified disease or other limited benefit coverage.

  • Health insurance policy means a policy that provides specified benefits for hospital and/or general treatment and meets all requirements under section 63-10 of the Private Health Insurance Act 2007.

  • SAP Policies means the operational guidelines and policies applied by SAP to provide and support the Cloud Service as incorporated in an Order Form.

  • Program Guidelines means any and all GLO-approved documents reflecting specific rules and regulations governing the implementation of the Program.

  • Health insurance means protection which provides payment of benefits for covered sickness or injury.

  • Health care coverage means any plan providing hospital, medical or surgical care coverage for

  • Operating Guidelines means the guidelines for the creation and redemption of Units of a class as set out in the schedule to each Participation Agreement as amended from time to time by the Manager with the approval of the Trustee, and where applicable, with the approval of HKSCC and the Conversion Agent, and following consultation, to the extent reasonably practicable, with the relevant Participating Dealers subject always, in respect of the relevant Operating Guidelines for a Participating Dealer, any amendment being notified in writing by the Manager in advance to the relevant Participating Dealer. Unless otherwise specified, references to the Operating Guidelines shall be to the Operating Guidelines for the relevant Sub-Fund applicable at the time of the relevant Application.

  • Clinical practice guidelines means a systematically developed statement to assist

  • Policy means Related Party Transaction Policy.

  • Consulting Guidelines means the Guidelines on the Use of Consultants by Asian Development Bank and its Borrowers (2010, as amended from time to time);

  • Insurance Program or “program” shall mean a program which has been designated as a major program of PRISM under which participating members are protected against designated losses, either through joint purchase of primary or excess insurance, pooling of self-insured claims or losses, purchased insurance or any other combination as determined by the Board of Directors. The Board of Directors, the Executive Committee, or a program’s governing committee may determine applicable criteria for determining eligibility in any insurance program, as well as establishing program policies and procedures.

  • Lot coverage means the portion or percentage of the area of a lot upon which buildings are erected.

  • Procurement Guidelines means the “Guidelines: Procurement under IBRD Loans and XXX Credits” published by the Bank in May 2004 and revised in October, 2006.

  • Coverage means the types of persons to be eligible as the beneficiaries of the Scheme to health services provided under the Scheme, subject to the terms, conditions and limitations.

  • Guidelines means the Instructions to Authors available on the Xxxxxxx Science website, as well as the Aims & Scope applicable to the relevant Xxxxxxx Science publication). Xxxxxxx Science’s nominated service provider, Xxxxxxx Science, offers English language support services which Assignor may elect to utilise in respect of the Work by completing the applicable box in Schedule 1: Details of the Work. The provision of such services by Xxxxxxx Science shall be subject to Xxxxxxx 2 [v.122016] Science’s prevailing terms and rates relating to such type of optional support.

  • Policies and Procedures means the written policies and procedures of the Client in any way related to the Services, including any such policies and procedures contained in the Organic Documents and the Offering Documents.

  • Federal poverty guidelines means the poverty guidelines published annually in the Federal Register by the United States Department of Health and Human Services under its authority to revise the poverty line under section 673(2) of subtitle B of title VI of the omnibus budget reconciliation act of 1981, 42 USC 9902.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Environmental and Social Standards or “ESSs” means, collectively: