Predetermination definition
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.
The Predetermination of Benefits procedure will enable Delta Plan of Ohio to verify eligibility and state the amount of benefit payable by your program.
Predetermination should not be requested unless total charges for a proposed treatment plan exceed $200.
Although not required, Predetermination helps avoid confusion regarding Delta Dental’s payment and your financial obligation to the Dentist.
Separate from any required Prior Authorization, Delta Dental encourages Predetermination of cases involving costly or extensive treatment plans.
More Definitions of Predetermination
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 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 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 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.
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 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 determination of eligibility under RCW 50A.15.010 and benefit amount and duration under RCW 50A.15.020, which occurs before the employee's qualifying event.