Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4)] .
Appears in 3 contracts
Samples: Contract (Sierra Health Services Inc), Wellcare Health Plans, Inc., Pacificare Health Systems Inc /De/
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3services.[422.152(B)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4services. [422.152(B)(4)] ].
Appears in 2 contracts
Samples: HealthSpring, Inc., HealthSpring, Inc.
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4)] ].
Appears in 2 contracts
Samples: Sierra Health Services Inc, Pacificare Health Systems Inc /De/
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3services. [422.152(b)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4services. [422.152(b)(4)] .
Appears in 2 contracts
Samples: Wellcare Health Plans, Inc., Wellcare Health Plans, Inc.
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3SERVICES.[422.152(B)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4services. [422.152(B)(4)] ].
Appears in 2 contracts
Samples: HealthSpring, Inc., HealthSpring, Inc.
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3SERVICES.[422.152(b)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4)] ].
Appears in 1 contract
Samples: Pacificare Health Systems Inc /De/
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3SERVICES.[422.152(b)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4)] .
Appears in 1 contract
Samples: Pacificare Health Systems Inc /De/
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4services. [422.152(b)(4)] ].
Appears in 1 contract
Samples: Wellcare Health Plans, Inc.
Utilization Review. If the The M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3services. [422.152(b)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4services. [422.152(b)(4)] ].
Appears in 1 contract
Samples: Wellcare Health Plans, Inc.
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3services. [422.152(b)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4services. [422.152(b)(4)] ].
Appears in 1 contract
Samples: HealthSpring, Inc.
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4)] . 4.
Appears in 1 contract
Samples: Pacificare Health Systems Inc /De/
Utilization Review. If the M+C Organization uses written protocols for utilization review, those policies and procedures must reflect current standards of medical practice in processing requests for initial or continued authorization of services.[422.152(b)(3services.[422.l52(B)(3)]. The M+C Organization must also have in effect mechanisms to detect both underutilization and overutilization of services.[422.152(b)(4services. [422.152(B)(4)] ].
Appears in 1 contract
Samples: HealthSpring, Inc.