Second Level Review definition

Second Level Review means a review performed by a Division

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Second Level Review means a review performed by a Division Medical Director who has the appropriate clinical expertise in managing a Member’s condition or disease. Second Level Review is used to screen for medical necessity and compare the findings to clinical data in the Member’s medical record to ensure Division Members are receiving medically appropriate and high quality care.

Second Level Review means a review of a First Level Review decision by an internal review committee. (See section 13.)

Examples of Second Level Review in a sentence

Second Level Review • The second level review must be initiated within 10 business days of the first level ▇▇▇▇▇▇ will coordinate with SBDBH on dispute resolutions and agrees to participate in a dispute resolution process in accordance to Title 9, CCR, Section 1850.505 to include: First Level Review • The process will be initiated within 45 calendar days from the disputed event.
Second Level Review decision • SBDBH will use its Director or Director’s designee as a second level reviewer.
Provider must submit a request for a Second Level Review within 60 days of the date of the letter communicating the First Level Review decision.
None of the mid-year Ratings or Comments, or Annual Ratings or Comments, or Second Level Review decisions, may be grieved.
If there is a lack of concurrence between the Evaluator of Record and the person conducting the Second Level Review, the Superintendent or his designee and a designee chosen by the Association will meet with the evaluators to reach a concurrence.
If the Second Level Review is adverse Provider may have the decision submitted to arbitration pursuant to the arbitration process set forth in the Agreement and the Administrative Guidelines.
The Second Level Review decision will be binding on Cigna and Provider if the resolution is accepted by Provider.
Provider must submit a request for arbitration within 12 months of the date of the letter communicating the Second Level Review decision.

More Definitions of Second Level Review

Second Level Review means an evaluation of an enrolled person or their medical record to assess the adequacy and clinical soundness of their assessment and treatment plan, to verify determination of serious mental illness, and/or to deny admission or continued stay to an Acute Inpatient Hospital, Inpatient Psychiatric Hospital, Inpatient Psychiatric Facility for Persons Under 21 Years of Age or Institution for Mental Disease for persons 65 years of age or older.

Second Level Review means a review performed by a Division of Developmental Disabilities (Division) Medical Director who has the appropriate clinical expertise in managing a Member’s condition or disease. Second Level Review is used to screen for