The review of the health plan's determination that a requested or provided health care service or treatment health care service is not or was not medically necessary. This review is performed by personnel working at or associated with the health plan. The ACA requires all plans to conduct an internal review upon request of the patient or the patient's representative. Minnesota's internal review process is outlined in Minn. Stat. 62Q.68 through 62Q.72.
- Browse Related Terms: Capitation, claim, External Review, Federally Qualified Health Center (FQHC), Fee-for-Service, Health Care Workforce Incentive, Home Health Care, Internal review, Member Survey Results, Original Medicare, Penalty, Uncompensated Care, Value-Based Purchasing (VBP)