Medical review definition

Medical review means a clinical evaluation of documentation conducted by AHCCCS or a contractor for purposes of prior authorization, concurrent review, post-payment review, or determining medical necessity. The criteria for medical review are established by AHCCCS or a contractor based on medical practice standards that are updated periodically to reflect changes in medical care.

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Medical review means a review involving clinical judgment of a claim or a request for a service before or after it is paid or rendered to ensure that services provided to a member are medically necessary and covered services and that required authorizations are obtained by the provider. The criteria for medical review are established by the contractor based on medical practice standards that are updated periodically to reflect changes in medical care.

Medical review means a process by which certain claims submitted to the Medicaid fiscal agent for payment are reviewed by Agency department medical consultants to determine their final adjudication.

Examples of Medical review in a sentence

All Product literature, labeling and the use of ReShape Medical logos, templates or trademarks is subject to ReShape Medical review and approval.
Medical review is required to assure an accurate positive result.
After the employee has been provided an opportunity to consult with the Medical review officer and the MRO determines that the test is positive the City will be notified.
Medical review officers are medical or osteopathic physicians duly licensed in the state in which they practice medicine and are certified as Medical Review Officers by the American Association of Medical Review Officers or the American College of Occupational and Environmental Medicine.
The testing process consists of three key stages Collection of the specimen to be analysed, Specimen analysis by an independent laboratory and Medical review to verify the collection, analysis of the specimen.

More Definitions of Medical review

Medical review means the procedure for evaluation by health care professionals of the quality and efficiency of services ordered or performed by other health care professionals and such other functions considered to be “peer review” within the meaning of such term as set forth in Section 19a-17b(s) of the Connecticut General Statutes, as amended from time to time. Medical review includes, but is not limited to, credentialing and privileging decisions made pursuant to Article III of these Bylaws, collegial and other informal efforts to improve practitioner performance, and any formal proceedings initiated under Articles IX and X of these Bylaws. Medical review activities shall be kept in strictest confidence.

Medical review means a clinical evaluation of documenta- tion conducted by AHCCCS or a contractor for purposes of prior authorization, concurrent review, post-payment review, or determining medical necessity. The criteria for medical

Medical review means the review of a provider’s medical records by, or in consultation with, a medical staff composed of persons who are employed by the [Health

Medical review means the review of a provider’s medical records by, or in consultation with, [the] a medical staff composed of persons who are employed by the health division [.] or have a contract with the health division for the performance of those services.

Medical review means the review of a provider’s medical records by, or in consultation with, the medical staff employed by the health division.]

Medical review means the processing of a Claim to determine if it is eligible for payment on any Matrix Level that would qualify the Claimant for Incremental Matrix Compensation Benefits, as described in Section II.I.

Medical review means a clinical evaluation of documentation conducted by AHCCCS or a contractor for purposes of prior authorization, concurrent review, post-payment review, or