Examples of Review organization in a sentence
The Appeals Coordinator or an External Review organization shall render its independent evaluation so as to comply with and achieve the intended purpose of the Primary Coverage Criteria and other provisions of this Plan.
For urgent cases involving imminent and serious threat to your health, including but not limited to: potential loss of life, limb or major bodily function, severe pain, or the immediate and serious deterioration of your health, the Independent Medical Review organization must provide its determination within three (3) business days.
If the Medical Consultant determines that a claim may not be Medically Necessary, then the claim is referred to PCS, who obtains an outside Medical Review organization for utilization review before final determination.
Review organization memberships annually to ensure that they maintain the minimum membership standards.
Decisions are made by Mass General Brigham Health Plan or a designated Utilization Review organization within two (2) working days of obtaining all necessary information, including any necessary evaluations and/or second opinions.