Utilization Management. a process of evaluating and determining coverage for, and appropriateness of, medical care services and Behavioral Health Services, as well as providing needed assistance to clinicians or patients, in cooperation with other parties, to ensure appropriate use of resources, which can be done on a prospective or retrospective basis, including service authorization and prior authorization.
Appears in 5 contracts
Sources: Accountable Care Partnership Plan Contract, Contract, Accountable Care Partnership Plan Contract
Utilization Management. a A process of evaluating and determining coverage for, for and appropriateness of, medical care services and Behavioral Health Services, of Covered Services as well as providing needed assistance to clinicians or patients, in cooperation with other parties, to ensure appropriate use of resources, which can be done on a prospective or retrospective basis, including service authorization and prior authorization.
Appears in 4 contracts
Sources: Contract for Senior Care Options Plans, Senior Care Options Contract, Contract for One Care Plans
Utilization Management. a A process of evaluating and determining coverage for, for and appropriateness of, medical care services and Behavioral Health Services, of Covered Services as well as providing needed assistance to clinicians or patients, in cooperation with other parties, to ensure appropriate use of resources, which can be done on a prospective or retrospective basis, including service authorization and prior authorization.. Waste - Misuse of funds or resources through excessive or nonessential expenditures Contractor Responsibilities
Appears in 1 contract
Sources: Senior Care Options Contract