Medical Review Organization definition

Medical Review Organization means Anthem Blue Cross as retained by the District in connection with the operation of the Medical Review Program portion of the Plan, whose medical specialists consult with an Eligible Employee, Eligible Retiree, or Eligible Dependent and their Physician with regard to recommended medical care and treatment.
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Medical Review Organization or "MRO" means an organization of health care professionals who are licensed in New Jersey, which is certified by the Commissioner to engage in unbiased medical review of the medical care provided to persons injured in automobile accidents in accordance with N.J.S.A. 39:6A-5.2 and this subchapter. The term includes either ;
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Examples of Medical Review Organization in a sentence

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

  • The state contractor is also known as the Independent Medical Review Organization (IMRO).

  • You are not required to participate in the Health Plan’s grievance process prior to seeking an independent medical review of this decision.The Independent Medical Review Organization will complete its review within 30 days of receipt of your application and supporting documentation.

  • Any relevant medical records kept by the Company or Physician and discovered or developed after the initial documents were provided to the Independent Medical Review Organization shall be forwarded immediately to the Independent Medical Review Organization.

  • This applica- tion deadline may be extended by the DMHC for good cause.If your case is eligible for an IMR, the dispute will be submitted to an Independent Medical Review Organization (IRO) contracted with the DMHC for review by one or more expert re- viewers, independent of Health Net.

  • This application deadline may be extended by the DMHC for good cause.If your case is eligible for an IMR, the dispute will be submitted to an Independent Medical Review Organization (IRO) contracted with the DMHC for review by one or more expert reviewers, inde- pendent of Blue Shield.

  • If the Department of Managed Health Care approves the Member’s request, the Member’s Appeal will be submitted to the Independent Medical Review Organization for review by a medical specialist, or a panel of medical specialists.

  • Upon receipt of the additional information, MCERA and its medical consultant, Managed Medical Review Organization Incorporated (MMRO) may refer the application to an independent medical advisor to summarize the medical evidence and provide an opinion on permanent incapacitation and, where appropriate, service connection.

  • MCERA and its medical consultant, Managed Medical Review Organization Incorporated (MMRO) may obtain additional evidence, where necessary including medical and personnel records (see Step 2), or it may request an additional medical evaluation or investigation.

  • This timeframe may be extended by up to 3 calendar days if there is a delay in providing any documents which the Independent Medical Review Organization requests for review.

Related to Medical Review Organization

  • Utilization review organization means an entity that conducts utilization review, other than a health carrier performing a review for its own health benefit plans.

  • 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.

  • Review organization means a disability insurer regulated

  • 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.

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

  • 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.

  • Stewardship organization means an organization, association, or

  • Procurement organization means an eye bank, organ procurement organization, or tissue bank.

  • Provider Organization means a group practice, facility, or organization that is:

  • 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.

  • 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.

  • CMS means the Centers for Medicare and Medicaid Services.

  • Health care organization ’ means any person or en-

  • medical surveillance means a planned programme or periodic examination (which may include clinical examinations, biological monitoring or medical tests) of employees by an occupational health practitioner or, in prescribed cases, by an occupational medicine practitioner;

  • 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.

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

  • Health plan or "health benefit plan" means any policy,

  • Designated chemical dependency specialist means a person

  • 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.

  • Organ procurement organization means a person designated by the Secretary of the United States Department of Health and Human Services as an organ procurement organization.

  • Medical Reimbursement Programs means a collective reference to the Medicare, Medicaid and TRICARE programs and any other health care program operated by or financed in whole or in part by any foreign or domestic federal, state or local government.

  • Radiologist assistant means an individual who has met the requirements of the Board for licensure

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

  • Professional employer organization means an employee leasing

  • Metropolitan planning organization means the same as that term is defined in Section 72-1-208.5.