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What Is A Retrospective Adverse Determination?

April 26, 2017adverse determination retrospective

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What Is A Retrospective Adverse Determination?

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A retrospective adverse determination is a determination for which utilization review was initiated after health care services have been provided. Retrospective adverse determination does not mean a pre-authorization determination or an initial determination involving continued or extended health care services, or additional services for a patient undergoing a course of continued treatment.