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Provider Manual Section 5.0 Utilization Management Table of Contents 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8Utilization Management Review Criteria/Standards for Review Authorization Requirements Online Authorization Inpatient
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Review criteria standards for review are the specific guidelines or benchmarks used to evaluate the quality, relevance, and effectiveness of a review process or outcome.
Any individual, organization, or entity conducting a review process or evaluation may be required to file review criteria standards for review.
Review criteria standards for review can be filled out by following the instructions provided by the governing body or regulatory agency overseeing the review process.
The purpose of review criteria standards for review is to ensure consistency, transparency, and accountability in the review process, and to help stakeholders understand and evaluate the outcomes of the review.
The information that must be reported on review criteria standards for review may include the specific criteria used for evaluation, the methodology and process used in the review, and the results and conclusions of the review.
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