Utilization management section means “you or your authorized representative.” Your representative will also receive all notices and benefit determinations.
Utilization management means a system for reviewing the
Utilization management means a set of formal techniques designed to monitor the
Examples of Utilization management in a sentence
Utilization management strategies such as quantity limits, step therapy and Prior Authorization criteria are reviewed and approved by the P & T committee.
Utilization management protocols for I/DD services shall include a process to accelerate access to necessary services commensurate with an individual’s need.
Utilization management may be referred to as Medical Necessity reviews, utilization review (UR), or medical management reviews.
Integration of Utilization Management Data Utilization management data is an integral part of the SBHO overall quality improvement strategy.
Utilization management decisions are based only on appropriateness of care and service.
More Definitions of Utilization management
Utilization management means a set of formal techniques designed to monitor the use of, or evaluate the medical necessity, appropriateness, efficacy, or efficiency of, health care services, procedures, or settings.
Utilization management means a system for administering some or all of an insurer’s decision point review plan, including but not limited to, receiving and responding to decision point review and precertification requests, making determination of medical necessity, scheduling and performing independent medical examinations (IMEs) bill review and handling of provider appeals.
Utilization management means a system for reviewing the appropriate and efficient allocation of health care services under a health benefits plan according to specified guidelines, in order to recommend or determine whether, or to what extent, a health care service given or proposed to be given to a covered person should or will be reimbursed, covered, paid for, or otherwise provided under the plan. The system may include preadmission certification, the application of practice guidelines, continued stay review, discharge planning, preauthorization of ambulatory care procedures, and retrospective review.
Utilization management means a system for reviewing the appropriate and
Utilization management means a set of formal
Utilization management means the evaluation of medical necessity and appropriateness of the use of health care services, procedures, and facilities utilized by a Covered Person under the terms of the Plan.
Utilization management means a system for reviewing the appropriate and efficient allocation of health care services under a health benefits plan according to specified guidelines, in order to recommend or determine whether, or to what extent, a vision care service either given or proposed to be given to a Member shall be deemed to be a Covered Service hereunder. The system may include, but shall not be limited to: preadmission certification, the application of practice guidelines, continued stay review, discharge planning, preauthorization of ambulatory care procedures and retrospective review.