Medically Appropriate definition

Medically Appropriate means services and medical supplies required for prevention, diagnosis, or treatment of a physical or behavioral health condition or injuries that are:

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Medically Appropriate means the recipient or self-donor meets the criteria for a transplant established by AHH.

Medically Appropriate means health services, items, or medical supplies that are:

Examples of Medically Appropriate in a sentence

Utilization review and quality management programs shall be established to review whether services rendered by PROVIDER were Medically Appropriate and to determine the quality of Covered Services furnished by PROVIDER to Members.
PROVIDER shall provide all Medically Appropriate Covered Services to Members within the scope of his/her/its license, and shall manage, coordinate and monitor all such care rendered to each such Member to ensure that it is cost-effective and Medically Appropriate.
Pursuant to and in accordance with 42 CFR §438.206(c)(1), PROVIDER and Participating Provider(s) agree to be available to provide Covered Services for Medically Appropriate care, taking into account the urgency of the need for services and when necessary and appropriate, to provide Covered Services for Medically Appropriate emergency care.
A process, independent of all affected parties, to determine if a health care service is Medically Necessary and Medically Appropriate, experimental/investigational.
Pursuant to OAR 410-141-3120, Contractor shall coordinate with Medicare payers and Providers as Medically Appropriate to coordinate the care and benefits of Members who are eligible for both Medicaid and Medicare.

More Definitions of Medically Appropriate

Medically Appropriate means services or supplies, which the Company determines, in the exercise of its discretion, are performed or provided according to generally professionally accepted standards of medical practice for the condition being treated.

Medically Appropriate means services and medical supplies that are required for prevention, diagnosis, or treatment of a health condition that encompasses physical or mental conditions or injuries and that are:

Medically Appropriate means prescription drugs that under the applicable standard of care are appropriate:

Medically Appropriate means prescription drugs that under the applicable standard of care are appropriate: (a) To improve or preserve health, life, or function; (b) to slow the deterioration of health, life, or function; or (c) for the early screening, prevention, evaluation, diagnosis, or treatment of a disease, condition, illness, or injury.

Medically Appropriate. With respect to the Medicare and/or Medicare Advantage program, in order for services provided to be deemed Medically Necessary or Medically Appropriate, Covered Services must: (1) be recommended by a PROVIDER who is treating the Member and practicing within the scope of her/his license and (2) satisfy each and every one of the following criteria:

Medically Appropriate means the recipient or self-donor meets the criteria for a transplant established by the Plan.

Medically Appropriate means the responding Ambulance Provider on scene will use its clinical judgment and follow its protocols under the medical direction of their Medical Director or online Medical Control, including but not limited to its patient disposition guidelines, to make an initial assessment based on the patient’s symptoms, which will determine the services needed and the disposition options to be considered to meet the medical needs of the patient.

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