External review organization definition

External review organization means an entity that conducts independent external reviews of adverse decisions pursuant to a contract with the commissioner. Such entity shall be a nationally accredited external review organization which utilizes health care providers actively engaged in the practice of their profession in the state of Kansas who are qualified and credentialed with respect to the health care service review. In the event the entity has no Kansas providers available who are qualified and credentialed with respect to the review of any case, the external review organization shall have the discretion to employ health care providers who actively engage in such health care provider's practice outside the state of Kansas.
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External review organization means an entity that conducts independent external reviews of adverse determinations and final adverse determinations;
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External review organization means an entity that conducts independent external reviews of adverse determinations and final adverse determinations and whose accreditation or certification has been reviewed and approved by the Department of Insurance.
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Examples of External review organization in a sentence

  • External review organization" means an entity that conducts independent external reviews of adverse decisions pursuant to a contract with the commissioner.

  • External review organization means an organization that has contracted with a hospital to provide external review of PCI cases and that maintains appropriate oversight of each external reviewer who evaluates PCI cases for a hospital.


More Definitions of External review organization

External review organization means an entity that conducts independent External Reviews of Adverse Decisions pursuant to a contract with the Kansas Insurance Department.
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External review organization means an organization that has contracted with a hospital to provide external review of PCI cases and that maintains appropriate oversight of each external reviewer who evaluates PCI cases for a hospital. The term includes an organization that has been approved by the Commission, as provided in Section .08D, that uses a Commission- approved blinded system for external review.
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External review organization means an entity that conducts independent external
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External review organization means an organization that has contracted with a hospital to provide external review of PCI cases and that maintains appropriate oversight of each external reviewer who evaluates PCI cases for a hospital. The term includes an
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External review organization means an entity that conducts independent external reviews of adverse determinations and final adverse determinations of a health carrier regarding medical necessity, appropriateness, healthcare setting, level of care or effectiveness of a healthcare service or treatment, or healthcare provider compensation;
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Related to External review organization

  • External Review means an independent review of an Adverse Benefit Determination conducted by an Independent Review Organization.

  • Review organization means a disability insurer regulated

  • Independent review organization means an entity that is accredited to conduct independent external reviews of adverse benefit determinations.

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

  • Stewardship organization means an organization, association, or

  • Procurement organization means an eye bank, organ procurement organization, or tissue bank.

  • Provider Organization means a group practice, facility, or organization that is:

  • Business organization means an individual, partnership, association, joint stock company, trust, corporation or other legal business entity or successor thereof.

  • Sponsoring organization means any organization that establishes,

  • Regional integration organization means an organization constituted by sovereign States of a given region, to which its member States have transferred competence in respect of matters governed by this Convention. Such organizations shall declare, in their instruments of formal confirmation or accession, the extent of their competence with respect to matters governed by this Convention. Subsequently, they shall inform the depositary of any substantial modification in the extent of their competence.

  • External Resource means a generation resource located outside the metered boundaries of the PJM Region.

  • ADR Organization means The American Arbitration Association or, if The American Arbitration Association no longer exists or if its ADR Rules would no longer permit mediation or arbitration, as applicable, of the dispute, another nationally recognized mediation or arbitration organization selected by the Sponsor.

  • Member organization means any individual, corporation, limited liability company, partnership, or association that belongs to an association.

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Professional employer organization means an employee leasing

  • Fraternal organization means an organization, except a school fraternity, which is a

  • Health care organization ’ means any person or en-

  • Religious organization means a church, ecclesiastical corporation, or group, not organized for pecuniary profit, that gathers for mutual support and edification in piety or worship of a supreme deity.

  • Lead organization means a trade organization, labor organization or other incorporated entity representing a group of businesses that is the applicant for a business network project.

  • Educational organization means a nonprofit public or private elementary or

  • Organ procurement organization means a person designated by the Secretary of the United States Department of Health and Human Services as an organ procurement organization.

  • Metropolitan planning organization means the same as that term is defined in Section 72-1-208.5.

  • Student organization means a group, club or organization having students as its primary members or participants. It includes grade levels, classes, teams, activities or particular school events. A student organization does not have to be an official school organization to come within the terms of this definition.

  • Nonprofit organization means a university or other institution of higher education or an organization of the type described in section 501(c)(3) of the Internal Revenue Code of 1954 (26 U.S.C. 501(c) and exempt from taxation under section 501(a) of the Internal Revenue Code (25 U.S.C. 501(a)) or any nonprofit scientific or educational organization qualified under a state nonprofit organization statute.

  • Architectural Review Committee or “ARC” shall mean the architectural review committee established by the Organization to review plans submitted to the Organization for architectural review.

  • Institutional Review Board or “IRB” means, in accordance with 45 C.F.R. Part 46, 21 C.F.R. part 56, and other applicable regulations, an independent body comprising medical, scientific, and nonscientific members, whose responsibility is to ensure the protection of the rights, safety, and well-being of the Human Subjects involved in a study.