Predetermination means a system that requires a Plan Provider to get approval from SHL before providing non-emergent healthcare services to an Insured for those services to be considered Covered Services. Prior Authorization is not an agreement to pay for a service.
Predetermination means a system that requires a Plan Provider to get approval from SHL before providing non-emergent healthcare services to a Insured for those services to be considered Covered Services. Prior Authorization is not an agreement to pay for a service.
Predetermination means an estimation of the allowable Benefits under the Contract for the services proposed, assuming the person is an eligible Enrollee.
Examples of Predetermination in a sentence
The parties acknowledge this Predetermination Settlement Agreement is a voluntary and full settlement of the disputed complaint.
Predetermination of Benefits is a voluntary review of a Dentist’s proposed treatment plan and expected charges.
Please note: Northeast Delta Dental strongly encourages Predetermination of cases involving costly or extensive treatment plans.
If there is no Predetermination of Benefits, Cigna will determine covered dental expenses when it receives a claim.Review of proposed treatment is advised whenever extensive dental work is recommended when charges exceed$500.Predetermination of Benefits is not a guarantee of a set payment.
In compliance with said Pennsylvania Prevailing Wage Act, the Prevailing Minimum Wage Predetermination, as approved by the Secretary, is attached hereto and made a part hereof.
More Definitions of Predetermination
Predetermination means the pretreatment review that is used to determine the eligibility of the individual and the amount of coverage for services in accordance with the Schedule of Benefits.
Predetermination means we assess the individual’s entry clearance application before they give their biometrics and if they meet the requirements of the relevant Immigration Rules a provisional decision is made, subject to the individual attending a VAC and enrolling their biometrics (where the pre- determination is positive, entry clearance will only be granted after biometrics are submitted and background checks are completed and there are no adverse results which would mean the individual does not meet the requirements of the Immigration Rules)
Predetermination means a voluntary and optional process where, at the request of a Subscriber, Eligible Dependent or Dentist, Delta Dental issues a written estimate of Benefits which may be available for proposed dental services or supplies under the terms of the Subscriber’s Plan. Predetermination is provided for informational purposes only and is not required in advance of obtaining dental care or as a prerequisite or condition for approval of future dental benefits payment. The Benefits estimate provided on a Predetermination notice is determined based on the Benefits available for the Eligible Person on the date the notice is issued, and is not a guarantee of future dental benefits payment. Availability of Benefits at the time a dental service is completed depends on factors such as, but not limited to, eligibility for Benefits, annual or lifetime Maximum Payments, coordination of benefits, Plan and Dentist status, Plan limitations and other Plan provisions. A request for a Predetermination is not a claim for Benefits or a preauthorization, precertification or other reservation of future benefits.
Predetermination means a procedure similar to, but of less intensity than an archaeological resource survey. Its purpose is to determine whether an archaeological site is likely to be present or
Predetermination means a procedure similar to, but of less intensity than an archaeological resource survey. Its purpose is to determine whether an archaeological site is likely to be present or absent on a parcel, and based on that determination recommend whether or not to proceed with an archaeological resource survey.
Predetermination means a written report prepared by a Dentist of Practitioner and reviewed and approved by SHL’s Dental Director describing the recommended treatment for any dental disease, defect, Injury or other condition as a result of a Dentist’s or
Predetermination means the pre-treatment review by the Plan of a Treatment Plan to determine the eligibility of the Plan Member, the coverage for Services and the allowance for such Services in accordance with the Plan.