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  • Timeframe
  • Uilization Review Standards - Timeframe, Procedures and Notice - On or After January 1, 2013. (ca.gov)
  • Expedited review (within 72 hours of the request) is available when the injured worker faces an imminent and serious health threat or when the normal timeframe for the decision-making process would be detrimental to the injured worker's life or health or could jeopardize the worker's permanent ability to regain maximum function. (cmanet.org)
  • concurrent review
  • A DWC Form RFA transmitted by facsimile after 5:30 PM Pacific Time shall be deemed to have been received by the claims administrator on the following business day, except in the case of an expedited or concurrent review. (ca.gov)
  • organization
  • 1) For purposes of this section, the DWC Form RFA shall be deemed to have been received by the claims administrator or its utilization review organization by facsimile or by electronic mail on the date the form was received if the receiving facsimile or electronic mail address electronically date stamps the transmission when received. (ca.gov)
  • If there is no electronically stamped date recorded, then the date the form was transmitted shall be deemed to be the date the form was received by the claims administrator or the claims administrator's utilization review organization. (ca.gov)
  • The regulations authorize DWC to conduct periodic reviews of all utilization review organizations (URO), including a review of any credible complaints against the organization received by the DWC Administrative Director. (cmanet.org)
  • appropriate
  • Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services. (concentra.com)
  • Prospective review is typically used as a method of reducing medically unnecessary admissions or procedures by denying cases that do not meet criteria, or allocating them to more appropriate care settings before the act. (wikipedia.org)
  • Claims
  • 1) If the claims administrator disputes liability under this subdivision, it may, no later than five (5) business days from receipt of the DWC Form RFA, issue a written decision deferring utilization review of the requested treatment unless the requesting physician has been previously notified under this subdivision of a dispute over liability and an explanation for the deferral of utilization review for a specific course of treatment. (ca.gov)
  • An insurance company may also use a TPA to manage its claims processing, provider networks, utilization review, or membership functions. (wikipedia.org)
  • methods
  • Assists Care Review Clinicians with methods to present cases at multidisciplinary rounds. (indeed.com)
  • This report describes development of utilization review methods adapted to publicly funded day treatment of individuals with serious mental illness and training of clinicians in new documentation skills. (springer.com)
  • decision
  • If the patient had continued to have chest pain or unstable angina, were receiving a nitroglycerin drip or had gotten a positive enzyme test result, then the review decision would have been quite different. (aafp.org)
  • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews. (concentra.com)
  • Review must be completed within 30 days of receiving the information required to make a decision. (cmanet.org)
  • data
  • Certification Reviews nursing plans to ensure data collected, nursing diagnoses, and proposed nursing care plans are relative… procedures. (glassdoor.com)
  • The scanned image can then be sent to other Walgreens locations through DWB (Dynamic Workload Balancing) or POWER (Pharmacy Optimization Within Enterprise Re-Engineering) for various purposes (data entry or data review). (wikipedia.org)
  • members
  • Utilizes established criteria to perform pre-certification review for all members requiring a procedure or service or with an admission diagnosis on the. (indeed.com)
  • cost
  • A possible reason for this failure is that consumers might increase utilization in response to less cost sharing under HMOs. (wikipedia.org)
  • patient
  • Medworxx Patient Flow systems were used by South Tees Hospitals NHS Foundation Trust in a Bed Utilisation Review Project in 2011 across the trust's multiple sites conducted by Model Advice DC Consulting Ltd. The trust subsequently adopted the company's web-based integrated patient flow solution. (wikipedia.org)
  • They have already worked together on patient flow diagnostic audits, known as Patient Throughput Reviews. (wikipedia.org)
  • individuals
  • Individuals conducting reviews should be board certified in those specialties they are reviewing, and practice within the same community. (entnet.org)
  • system
  • The Government of Maharashtra, decided to take a close review on the Water Supply System, granting aids and loan guarantees to the Urban Local Bodies for water management system schemes within the state. (ceinsys.com)
  • The defining characteristic of a rule-based machine learner is the identification and utilization of a set of relational rules that collectively represent the knowledge captured by the system. (wikipedia.org)
  • energy
  • M. 2009 he was Co-founder of Desertec Foundation, an international endeavour to realize a world-wide energy transition by the utilization of renewable energies. (wikipedia.org)