In Certain Situations, a Health Plan Can Use the Results

question 143

Multiple Choice

In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care. Such intervention can be based on the results of

• A) Prospective review
• B) Concurrent review
• C) Pending
• D) A, B, and C
• E) A and B only
• F) A and C only
• G) B only

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Definitions:

Implied Authority

The power or right assumed to be held by a person in a position of leadership or responsibility, based on the role rather than explicitly stated.

Maverick Buyers

Individuals within an organization who make unauthorized purchases outside of agreed contracts or procurement policies, often leading to inefficiencies and increased costs.

Apparent Authority

This refers to a situation where someone seems to have the power to act on behalf of a business or an organization, even if they haven't been officially given this authority.

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