Retrospective review definition

Retrospective review means a review of medical necessity conducted after services have been provided to a patient, but does not include the review of a claim that is limited to an evaluation of reimbursement levels, veracity of documentation, accuracy of coding, or adjudication for payment.

Retrospective review means the process of reviewing the medical necessity and reasonableness of health care that has been provided to an injured employee.

Retrospective review means utilization review conducted after medical services have been provided and for which approval has not already been given.

Examples of Retrospective review in a sentence

• Retrospective review does not include the review of a claim that is limited to the veracity of documentation or accuracy of coding.

• Retrospective review is a type of treatment review that occurs when the initial review of a Certification request takes place after services have been rendered.

• Retrospective review is performed when we are not notified of the service you received, and are therefore unable to perform the appropriate review prior to your discharge from the hospital or completion of outpatient treatment.

• Retrospective review may be performed to ensure documentation supports the medical necessity of the service when claims are submitted for the procedure codes listed within this handbook.4.1.1 Authorization Requirements‌Prior authorization requests may be submitted to the TMHP Prior Authorization Department via mail, fax, or the electronic portal.

• Retrospective review may be performed to ensure that the documentation supports the medical necessity of the service and any modifier used when billing the claim.

More Definitions of Retrospective review

Retrospective review means utilization review that is conducted after health care services have been provided to a covered person. "Retrospective review" does not include the review of a claim that is limited to an evaluation of reimbursement levels, or adjudication of payment;

Retrospective review means any review of a request for a benefit that is not a prospective review request. Retrospective review does not include the review of a claim that is limited to veracity of documentation or accuracy of coding; and

Retrospective review means utilization review that is conducted after health care

Retrospective review means a review, for coverage purposes, of medical necessity conducted after services have been provided to a patient.

Retrospective review means a review conducted after services have been provided to a covered person.

Retrospective review means the review conducted after services are provided to a client, to determine the medical necessity, appropriateness, and quality of the services provided.

Retrospective review means utilization review that is conducted after health care services have been provided to a covered person; and