Utilization Review. 6.6.1 Company shall not be required to pay any claim until it determines that Services provided to a Covered Person are Covered Services. 6.6.2 Company has the right to conduct utilization review on a prospective concurrent and/or retrospective basis, subject to compliance with PPACA applicable Claims Procedure Requirements.
Appears in 8 contracts
Sources: Group Health Insurance Agreement, Group Health Insurance Agreement, Group Health Insurance Agreement
Utilization Review. 6.6.1 6.5.1 Company shall not be required to pay any claim until it determines that Services provided to a Covered Person are Covered Services.
6.6.2 6.5.2 Company has the right to conduct utilization review on a prospective concurrent and/or retrospective basis, subject to compliance with PPACA applicable Claims Procedure Requirements.
Appears in 4 contracts
Sources: Health Insurance Agreement, Health Insurance Agreement, Health Insurance Agreement