320.000 – Medical Review

H-320.001: Medical Review, Professionally Directed

IMS supports professionally directed efforts to ensure that care provided to patients is of high quality, appropriate duration and is rendered in an appropriate setting at a reasonable cost. ...

H-320.001: Medical Review, Professionally Directed

IMS supports professionally directed efforts to ensure that care provided to patients is of high quality, appropriate duration and is rendered in an appropriate setting at a reasonable cost. ...

E-320.002: Medical Review, Hospital Preadmission Review/Certification

IMS encourages hospital medical staffs to support implementation of pre-admission certification programs which may be appropriate in instances where ...

H-320.003: Medical Review, Second Opinions

IMS reaffirms, while recognizing that the advisability of surgery or other specific therapy can be a matter of opinion, the right of a patient or a physician to freely ...

H-320.003: Medical Review, Second Opinions

IMS reaffirms, while recognizing that the advisability of surgery or other specific therapy can be a matter of opinion, the right of a patient or a physician to freely ...

H-320.004: Medical Review, Only a Physician Should Deny Hospital Admissions

IMS reaffirms its policy that only a physician should be permitted to deny admissions to the hospital. ...

H-320.004: Medical Review, Only a Physician Should Deny Hospital Admissions

IMS reaffirms its policy that only a physician should be permitted to deny admissions to the hospital. ...

H-320.007: Medical Review, Protect Physician-Patient Relationships

IMS supports continuing to protect physician-patient relationships and the quality of care from undue influence by third party payers and utilization review organizations. ...

H-320.007: Medical Review, Protect Physician-Patient Relationships

IMS supports continuing to protect physician-patient relationships and the quality of care from undue influence by third party payers and utilization review organizations. ...

E-320.008: Medical Review, Insurance Division Develop Rules

IMS supports continued work with the Insurance Division on the development of rules to alleviate the problems of utilization review, specifically rules that will require ...

E-320.008: Medical Review, Insurance Division Develop Rules

IMS supports continued work with the Insurance Division on the development of rules to alleviate the problems of utilization review, specifically rules that will require ...

H-320.009: Medical Review, Criteria Based on Sound Medical Judgments

IMS supports having itself and its delegates to the AMA work to ensure that third party payer review criteria be based on sound medical judgments developed by practicing ...

H-320.009: Medical Review, Criteria Based on Sound Medical Judgments

IMS supports having itself and its delegates to the AMA work to ensure that third party payer review criteria be based on sound medical judgments developed by practicing ...

H-320.011: Medical Review, Use of Medical Director Licensed in Iowa

IMS supports requiring each health benefit plan to establish a utilization review process that includes a medical director licensed in Iowa who is responsible for all ...

H-320.011: Medical Review, Use of Medical Director Licensed in Iowa

IMS supports requiring each health benefit plan to establish a utilization review process that includes a medical director licensed in Iowa who is responsible for all ...

H-320.012: Medical Review, Criteria Based on Physician-Developed, Scientifically Valid Research

IMS affirms that grading criteria, weighting elements, and computer algorithms, including but not limited to pre-admission procedures, medical necessity criteria ...

H-320.012: Medical Review, Criteria Based on Physician-Developed, Scientifically Valid Research

IMS affirms that grading criteria, weighting elements, and computer algorithms, including but not limited to pre-admission procedures, medical necessity criteria ...

H-320.013: Medical Review, Compliance with Ethical Standards

IMS supports all utilization review policies and procedures being carried out in compliance with recognized ethical standards, including the patient’s right to privacy. ...

H-320.013: Medical Review, Compliance with Ethical Standards

IMS supports all utilization review policies and procedures being carried out in compliance with recognized ethical standards, including the patient’s right to privacy. ...

H-320.014: Medical Review, Third Party Payer Requirements

IMS recommends that a third party payer which provides health benefits to enrollees residing in the state of Iowa, and conducts utilization review either directly or ...

H-320.014: Medical Review, Third Party Payer Requirements

IMS recommends that a third party payer which provides health benefits to enrollees residing in the state of Iowa, and conducts utilization review either directly or ...

H-320.015: Medical Review, Denial of Care

IMS supports legislation to assure that utilization review of denial of care is performed by a medical doctor or osteopathic doctor licensed in the ...

H-320.015: Medical Review, Denial of Care

IMS supports legislation to assure that utilization review of denial of care is performed by a medical doctor or osteopathic doctor licensed in the ...

H-320.016: Medical Review, Medical Necessity Appeals and Processes

IMS supports legislation to establish a maximum length of time for medical necessity appeals and processes, which relate to the severity of an illness or ...

H-320.016: Medical Review, Medical Necessity Appeals and Processes

IMS supports legislation to establish a maximum length of time for medical necessity appeals and processes, which relate to the severity of an illness or ...

H-320.018: Medical Review, Burden of Proof on Health Plans

IMS supports legislation to establish a presumption in law in favor of medical advisability or necessity determinations ...

H-320.018: Medical Review, Burden of Proof on Health Plans

IMS supports legislation to establish a presumption in law in favor of medical advisability or necessity determinations ...

H-320.020: Medical Review, External Review Process

IMS supports establishing a mechanism to assist physicians and their patients in utilizing the external review and other patient rights provisions of Iowa law and ...

H-320.020: Medical Review, External Review Process

IMS supports establishing a mechanism to assist physicians and their patients in utilizing the external review and other patient rights provisions of Iowa law and ...

H-320.021: Medical Review, Health Plan Accountability for Negligent Medical Necessity Decisions

IMS supports continuing to assure that health plans are legally accountable for negligent medical necessity decisions made by them that cause harm ...

H-320.021: Medical Review, Health Plan Accountability for Negligent Medical Necessity Decisions

IMS supports continuing to assure that health plans are legally accountable for negligent medical necessity decisions made by them that cause harm ...

B-320.022: Medical Review, Preauthorization

IMS believes that as third party payers develop preauthorization processes, those plans should assure adherence to identified medical practice standards. ...

B-320.022: Medical Review, Preauthorization

IMS believes that as third party payers develop preauthorization processes, those plans should assure adherence to identified medical practice standards. ...

H-320.023: Medical Review, Precertification Binding for Payment of Services

IMS supports advocating that precertification would be binding on insurance companies comparable to a contractual agreement necessitating ...

H-320.023: Medical Review, Precertification Binding for Payment of Services

IMS supports advocating that precertification would be binding on insurance companies comparable to a contractual agreement necessitating ...

PF-320.024: Medical Review, Prescription Drug Prior Authorizations

IMS supports insurance companies giving prompt responses to prescription drug prior authorization requests with annual public reporting when requests are denied. ...