Utilization Review Criteria Clause Samples
Utilization Review Criteria. Written guidelines used by The Plan in completing Prior Authorization.
Utilization Review NOTE: The Utilization Review process does not apply to Services that are not covered by Blue Shield because of a coverage determination made by Medicare. State law requires that health plans disclose to Sub- scribers and health plan providers the process used to authorize or deny health care services under the plan. Blue Shield has completed documentation of this process ("Utilization Review"), as required un- der Section 1363.5 of the California Health and Safety Code. To request a copy of the document describing this Utilization Review process, call the Customer Service Department at the telephone number indicated on your Identification Card.
Evaluation Criteria 5.2.1. The responses will be evaluated based on the following: (edit evaluation criteria below as appropriate for your project)
Selection Criteria Each Contract is secured by a new or used Motorcycle. No Contract has a Contract Rate less than 1.00%. Each Contract amortizes the amount financed over an original term no greater than 84 months (excluding periods of deferral of first payment). Each Contract has a Principal Balance of at least $500.00 as of the Cutoff Date.
Claims Review Methodology a. C laims Review Population. A description of the Population subject to the Quarterly Claims Review.
Classification Review Grand Valley State University and APSS shall jointly determine the review assessment survey instrument to be used at Grand Valley State University. The parties shall maintain a Joint Review Committee, composed of three members appointed by the Human Resources Office and three members appointed by the Alliance. Bargaining unit members questioning the assigned classification of their position may do so by using the following procedure: A. Meet with the Employment Manager in the Human Resources Office to discuss the review process, changes in their job responsibilities, duties and any other process questions they may have. B. PSS member will fill out the assessment survey and email to the Employment Manager along with any other documentation that supports the request. The survey instrument will be jointly administered/reviewed by the Assessment Team (consisting of the Employment Manager and an Alliance member of the Joint Review Committee). A meeting with the PSS is scheduled for a verbal review of the documentation and to answer any questions the Assessment Team may have. The supervisor or appointing officer is encouraged to attend. If the Assessment Team believes a job site visit is warranted as a result of the survey information, they will schedule a time for a joint visit. C. The completed survey instrument shall be coded. The survey results, as determined by the Assessment Team, shall be shared with the survey participant. D. After receiving the survey results, the survey participant, if they so choose shall have the opportunity to meet with the Joint Review Committee for additional input and appeal. Any additional information shall be reviewed by the Committee, and where the Committee feels it is necessary, the survey will be recoded, in a manner mutually agreeable. E. The Joint Review Committee shall then deliberate as to the merit of the upgrade requested by the participant. If the Committee is not able to reach a consensus, the University will decide on the classification. The Alliance may appeal that decision through the arbitration procedure of the collective bargaining agreement. Professional Support Staff members may engage in the review process no more than once per year. Supervisors questioning the assigned classification of a staff member’s position shall provide supporting rationale, complete an assessment survey instrument and discuss with Manager of Employment. The Manager of Employment shall notify an Alliance Representative that a Supervisor is reviewing a staff member’s classification. The review and outcome shall be completed within 45 working days unless the Alliance Representative and Manager of Employment mutually agreed to an extension. The Alliance will be provided with the scored instrument and any supporting rationale.