P

Term: Peer Clinical Review

A clinical review conducted by a Physician or other health professional when a request for an admission, procedure, or service was not approved during the Initial Clinical Review. The person conducting the Peer Clinical Review is called the Peer Clinical Reviewer. In the case of an appeal, the Peer Clinical Reviewer is a Physician or other health professional who holds an unrestricted license and is in the same or similar specialty and typically manages the medical condition procedures, or treatment under review. Generally, as a peer in a similar specialty, the individual must be in the same profession, i.e., the same licensure category as the ordering provider.


P

Term: Peer Clinical Review

A clinical review conducted by a Physician or other health professional when a request for an admission, procedure, or service was not approved during the Initial Clinical Review. The person conducting the Peer Clinical Review is called the Peer Clinical Reviewer. In the case of an appeal, the Peer Clinical Reviewer is a Physician or other health professional who holds an unrestricted license and is in the same or similar specialty and typically manages the medical condition procedures, or treatment under review. Generally, as a peer in a similar specialty, the individual must be in the same profession, i.e., the same licensure category as the ordering provider.


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