Medical necessity review definition

Medical necessity review means an assessment of current and recent behaviors and symptoms to determine whether an admission for inpatient mental illness or drug or alcohol dependence treatment or evaluation constitutes the least restrictive level of care necessary. The review shall be performed by a licensed mental health professional;
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Medical necessity review means a review of the social and medical needs of a resident, whose stay is being paid by
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Medical necessity review means an assessment of current and recent behaviors and symptoms to determine whether an admission for inpatient mental illness or drug or alcohol dependence treatment or evaluation constitutes the least restrictive level of care
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Examples of Medical necessity review in a sentence

  • Medical necessity review may take place prospectively, as part of the inpatient admission notification/concurrent review, or retrospectively.

  • Medical necessity review shall utilize an evidence-based and peer reviewed clinical review tool to be designated through rulemaking by the Commissioner of Human Services in consultation with the Department of Health.

  • Medical necessity review is required to determine if a specific organ or tissue transplant service will be covered.

  • Medical necessity review will be completed per the guidelines of the Plan.

  • On 3 May 2019, a presidential order was adopted to enhance the effectiveness of cultural and awareness-raising work, which specified the mandate of the National Council for Spiritual Enlightenment and approved a programme of measures aimed at improving the performance of local-level councils with responsibility for these and other issues.

  • Medical necessity review determinations for behavioral health care and substance abuse are made in accordance with The Mihalik Group’s Medical Necessity Manual for Behavioral Health, Meridian Medical Policy or CMS National or Local Coverage Determinations, as appropriate.

  • Council on 22 October 2008 approved the use of a combination of capping the size of the establishment and the active use of redeployment and vacancy opportunities to ratchet down the size of the organisation over time, as outlined in the report entitled Employment Stability through Change and Economic Downturn.

  • Gen- erally, unless an exception request is submitted and accepted, the prescriber will need to demonstrate that the patient has undergone the step therapy protocol before the payer will cover the medication.Medical Necessity Review Medical necessity review is needed when a clinician prescribes a medi- cation for which the payer protocol requires review, such as the sce- narios discussed above.

  • Medical necessity review procedures are disclosed to health care providers through provider manuals and newsletters.

  • Medical necessity review is required for all ABA services initially with a baseline and then, again, every 6 months.


More Definitions of Medical necessity review

Medical necessity review means a review of the social and medical needs of a resident, whose stay is being paid by Medicaid or Medicare or other third party payor, to determine the appropriate level of care of such resident;
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Medical necessity review means an assessment of current
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Related to Medical necessity review

  • Medical necessity means that the service or supply is provided by a physician or other health care provider exercising prudent clinical judgment for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and that provision of the service or supply is:

  • Utilization review plan or "plan" means a written procedure for performing review.

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Medical examination means the preliminary assessment of a person by an authorized health worker or by a person under the direct supervision of the competent authority, to determine the person’s health status and potential public health risk to others, and may include the scrutiny of health documents, and a physical examination when justified by the circumstances of the individual case;

  • Supervising physician means any physician licensed under Iowa Code chapter 148, 150, or 150A. The supervising physician is responsible for medical direction of emergency medical care personnel when such personnel are providing emergency medical care.

  • Medical Review Officer (MRO means a licensed M.D. or D.O. with knowledge of drug abuse disorders, employed or used by the City to review drug results in accordance with this procedure.

  • Medical cannabis dispensary means an organization issued a

  • psychiatric emergency medical condition means a Mental Disorder that manifests itself by acute symptoms of sufficient severity that it renders the patient as being either of the following:

  • Objective medical evidence means reports of examinations or treatments; medical

  • Primary care physician means a physician who is a family

  • Medical evaluation means the process of assessing an individual's health status that includes a medical history and a physical examination of an individual conducted by a licensed medical practitioner operating within the scope of his license.

  • Medical Review Officer (MRO) means a licensed physician responsible for receiving and reviewing laboratory results generated by the school district’s drug testing program and for evaluating medical explanations for certain drug tests.

  • Stewardship means the continuing obligation to provide the necessary maintenance, management, protection, husbandry and support for a natural area and natural values associated with that area.

  • Clinical review criteria means the written screening procedures, decision abstracts, clinical protocols, and practice guidelines used by a health carrier to determine the necessity and appropriateness of health care services.

  • Independent testing laboratory means an independent organization, accepted by the Contracting Officer, engaged to perform specific inspections or tests of the work, either at the site or elsewhere, and report the results of these inspections or tests.

  • Medical Specialist means any medical practitioner who is vocationally registered by the Medical Council under the Health Practitioners Competence Assurance Act 2003 in one of the approved branches of medicine and who is employed in either that branch of medicine or in a similar capacity with minimal oversight.

  • Medical Reimbursement Programs means a collective reference to the Medicare, Medicaid and TRICARE programs and any other health care program operated by or financed in whole or in part by any foreign or domestic federal, state or local government.

  • Licensed mental health professional or "LMHP" means a physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, certified psychiatric clinical nurse specialist, licensed behavior analyst, or licensed psychiatric/mental health nurse practitioner.

  • Medical cannabis means the same as that term is defined in Section 26-61a-102.

  • Designated mental health professional means a mental health

  • Medical history means information regarding any:

  • Qualified mental health professional means a licensed medical practitioner or any other person meeting the qualifications specified in OAR 309-019-0125.

  • Medical physicist means a person trained in evaluating the performance of mammography equipment and facility quality assurance programs and who meets the qualifications for a medical physicist set forth in 41.6(3)“c.”

  • Mental health professional means a psychiatrist,

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • Utilization review means the prospective (prior to), concurrent (during) or retrospective (after) review of any service to determine whether such service was properly authorized, constitutes a medically necessary service for purposes of benefit payment, and is a covered healthcare service under this plan. WE, US, and OUR means Blue Cross & Blue Shield of Rhode Island. WE, US, or OUR will have the same meaning whether italicized or not. YOU and YOUR means the subscriber or member enrolled for coverage under this agreement. YOU and YOUR will have the same meaning whether italicized or not.