Preservice review definition
Preservice review means the evaluation by the organization or a managed care vendor of a proposed medical service for medical necessity, appropriateness, and efficiency prior to the services being performed.
Examples of Preservice review in a sentence
Pre-service review must be obtained prior to receiving the additional services.
Retrospective utilization review may be conducted on post-service claims in situations where services are not subject to Pre-service review against clinical criteria.
Exceptions: Pre-service review is not required for inpatient Hospital Stays for the following services • Maternity care of 48 hours less following a normal delivery or 96 hours or less following a cesarean section, and • Mastectomy and lymph node dissection.