Utilization Review Services definition
Utilization Review Services means a service that a Defendant provides to a Payer that establishes mechanisms to monitor and control utilization of health care services and that is designed to control costs and assure quality of care by monitoring over-utilization of health care services, provided that such mechanisms are not used or designed to increase costs or utilization of health care services.
Utilization Review Services means a service that a Defendant provides to a Payer that establishes mechanisms to monitor and control utilization of health care services and that is designed to control costs and assure quality of care by monitoring
Utilization Review Services means a plan developed and/or administered by CN, Payor, or a duly designated third party, to monitor and review the delivery of Covered Services to determine whether such services are provided in a cost-efficient and appropriate manner.
Examples of Utilization Review Services in a sentence
If Utilization Review is the responsibility of the IPA, IPA agrees to provide Utilization Review Services as outlined in the delegated Utilization Management Agreement.
Utilization Review Director shall perform all such duties and responsibilities ("Utilization Review Services") in accordance with accepted professional standards, all applicable federal, state, and local laws and regulations, County policies, and JCAHO standards (if County maintains or seeks JCAHO accreditation), as the same may be revised from time to time.
The SFMTA wishes to provide Workers' Compensation ▇▇▇▇ Review and Utilization Review Services for the SFMTA's self-insured workers' compensation program.