Utilization review organization definition

Utilization review organization means an entity that conducts utilization review, other than a health carrier performing a review for its own health plans.

Utilization review organization means an entity that conducts utilization review, other

Utilization review organization means an entity that conducts utilization review, other than a health insuring corporation performing a review of its own health care plans.

Examples of Utilization review organization in a sentence

• Utilization review organization means an entity that conducts Utilization review, other than Us performing utilization review for Our own health benefit plans.

• Utilization review organization means an entity that conducts Utilization review, other than Us performing utilization review for Our own health benefit plans.Complaint SystemWithin 180 days after notice of an adverse determination of a claim, the covered person, or an authorized representative may file a written or oral complaint by sending Us a written request for review.

• Utilization review organization" means an entity that conducts utilization review, other than a health insuring corporation performing a review of its own health care plans.Sec.

• For purposes of this Section, the following definitions apply:Adverse Benefit Determination means a determination by Us or Our designee Utilization review organization that health care services provided or proposed to be provided are not Medically Necessary or are Experimental or Investigative.

• This determination is9 based on a review of the patient's or prescriber's request for an override,10 along with supporting rationale and documentation.11 (4) "Step therapy protocol" means a protocol or program that establishes the12 specific sequence in which prescription drugs for a specified medical13 condition are medically appropriate for a particular patient and are covered14 by an insurer or health plan.15 (5) "Utilization review organization" as defined in G.S. 59-50-61(a)(18).16 "§ 58-50-305.

More Definitions of Utilization review organization

Utilization review organization means an entity that conducts

Utilization review organization means an entity that

Utilization review organization means an entity that conducts utilization review for one or more of

Utilization review organization means an entity that conducts utilization review, other than an issuer performing utilization review for its own health benefit plans.

Utilization review organization means an entity that conducts utilization review, other than a health

Utilization review organization means an entity that conducts a utilization review, other than a carrier performing a utilization review for its own health benefit plans. [PL 2019, c. 295, §1 (NEW); RR 2019, c. 1, Pt. A, §26 (RAL).]

Utilization review organization means an entity that provides utilization review services.