Adverse Determination (Health Care) Law and Legal Definition
Adverse determination in the context of health care refers to the determination made by a health care plan or by a utilization review program, that a health care service is not medically necessary. It also refers to the decision taken by the Office of Personnel Management barring health care service providers or suppliers from participating in the health care program. Any health care services provider or supplier subject to an adverse determination by the Office under 5 USCS § 8902a (h)(1) section shall be entitled to reasonable notice, an opportunity to request a hearing of record, and to judicial review after the Office renders a final decision.
Legal Definition list
Related Legal Terms
- Accelerated Benefits (Health Care)
- Accumulation Value (Health Care)
- Actual Age (Health Care)
- Actuarial Equivalent (Health Care)
- Acute Care
- Additional Health Services
- Adequate Parental Care
- Adequate Veterinary Care
- Admitting Privileges (Health Care)
- Adoption and Foster Care Analysis and Reporting System (AFCARS)
