External Review means an independent review of an Adverse Benefit Determination conducted by an Independent Review Organization.
External Review means a review that is conducted by an independent review entity which meets specified criteria as established in KRS 304.17A-623, 304.17A-625, and 304.17A-627;
Examples of External Review in a sentence
The Insured, the Insured’s authorized representative, or Physician or health care provider has the right to file a Grievance, file an appeal, and have an External review.
More Definitions of External Review
External Review means an independent review of an Adverse Benefit Determination conducted by an Independent Review Organization. External Review is only available for a Final Adverse Benefit Determination based on Medical Necessity, appropriateness, health care setting, level of care, or effectiveness of a Covered Service.
External Review means a review conducted by persons from outside the resource center who represent the specialties that are required to be reviewed.
External Review means a school division-level academic review conducted by an organization or agency at the request of a local school board.
External Review means a review of an adverse benefit determination (including a final internal adverse
External Review means a process, independent of all affected parties, to determine if a health care service is medically necessary or experimental/ investigational.
External Review means a review by an independent physician as chosen by the Independent Review Organization. “Independent Review Organization” (IRO) means the entity with which the claims administrator has contracted to conduct external reviews for the plan.
External Review means a review that is conducted by an independent review entity