Common use of Administrative and Organizational Structure Clause in Contracts

Administrative and Organizational Structure. The Contractor shall maintain an administrative and organizational structure that supports effective and efficient delivery of integrated services to all members in a family. The organizational structure shall demonstrate a coordinated approach to managing the delivery of health care services to its Hoosier Healthwise members. The Contractor’s organizational structure shall support collection and integration of data from every aspect of its delivery system and its internal functional units to accurately report the Contractor’s performance. The Contractor shall also have policies and procedures in place that support the integration of financial and performance data and comply with all applicable federal and state requirements. Prior to the Contract effective date, FSSA will provide a series of orientation sessions to assist the Contractor in developing its internal operations to support the requirements of the Contract (i.e., data submission, data transmissions, reporting formats, etc.). The Contractor shall have in place sufficient administrative and clinical staff and organizational components to comply with all Hoosier Healthwise program requirements and standards. The Contractor shall manage the functional linkage of the following major operational areas:  Administrative and fiscal management  Member services  Provider services  Marketing  Provider enrollment  Network development and management  Quality management and improvement  Utilization and care management  Special investigations and waste, fraud and abuse detection  Behavioral and physical health  Information systems  Performance data reporting and encounter claims submission  Claims payments  Grievances and appeals

Administrative and Organizational Structure. The Contractor shall maintain an administrative and organizational structure that supports effective and efficient delivery of integrated services to all members in a family. The organizational structure shall demonstrate a coordinated approach to managing the delivery of health care services to its Hoosier Healthwise members. The Contractor’s organizational structure shall support collection and integration of data from every aspect of its delivery system and its internal functional units to accurately report the Contractor’s performance. The Contractor shall also have policies and procedures in place that support the integration of financial and performance data and comply with all applicable federal and state requirements. Prior to the Contract effective date, FSSA will provide a series of orientation sessions to assist the Contractor in developing its internal operations to support the requirements of the Contract (i.e., data submission, data transmissions, reporting formats, etc.). The Contractor shall have in place sufficient administrative and clinical staff and organizational components to comply with all Hoosier Healthwise program requirements and standards. The Contractor shall manage the functional linkage of the following major operational areas:  ▪ Administrative and fiscal management  ▪ Member services  ▪ Provider services  ▪ Marketing  ▪ Provider enrollment  ▪ Network development and management  ▪ Quality management and improvement  ▪ Utilization and care management  ▪ Special investigations and waste, fraud and abuse detection  ▪ Behavioral and physical health  ▪ Information systems  ▪ Performance data reporting and encounter claims submission  ▪ Claims payments  ▪ Grievances and appeals

Administrative and Organizational Structure. The Contractor shall maintain an administrative and organizational structure that supports effective and efficient delivery of integrated services to all members in a family. The organizational structure shall demonstrate a coordinated approach to managing the delivery of health care services to its Hoosier Healthwise membersHIP populations. The Contractor’s organizational structure shall support collection and integration of data from every aspect of its delivery system and its internal functional units to accurately report the Contractor’s performance. The Contractor shall also have policies and procedures in place that support the integration of financial and performance data and comply with all applicable federal and state requirements. Prior to the Contract effective date, FSSA will provide a series of orientation sessions to assist the Contractor in developing its internal operations to support the requirements of the Contract (i.e., data submission, data transmissions, reporting formats, etc.). The Contractor shall have in place sufficient administrative and clinical staff and organizational components to comply with all Hoosier Healthwise HIP program requirements and standards. The Contractor shall manage the functional linkage of the following major operational areas:  Administrative and fiscal management  Member services  Provider services  Marketing  Provider enrollment  Network development and management  Quality management and improvement  Utilization and care management  Special investigations and waste, fraud and abuse detection  Behavioral and physical health  POWER Account administration  POWER Account contribution collections  GTW program management  Information systems  Performance data reporting and encounter claims submission  Claims payments  Grievances and appealsappeals  Pharmacy Benefits Management

Administrative and Organizational Structure. The Contractor shall maintain an administrative and organizational structure that supports effective and efficient delivery of integrated services to all members in a family. The organizational structure shall demonstrate a coordinated approach to managing the delivery of health care services to its Hoosier Healthwise members. The Contractor’s organizational structure shall support collection and integration of data from every aspect of its delivery system and its internal functional units to accurately report the Contractor’s performance. The Contractor shall also have policies and procedures in place that support the integration of financial and performance data and comply with all applicable federal and state requirements. Prior to the Contract effective date, FSSA will provide a series of orientation sessions to assist the Contractor in developing its internal operations to support the requirements of the Contract (i.e., data submission, data transmissions, reporting formats, etc.). The Contractor shall have in place sufficient administrative and clinical staff and organizational components to comply with all Hoosier Healthwise program requirements and standards. The Contractor shall manage the functional linkage of the following major operational areas:   Administrative and fiscal management   Member services   Provider services   Marketing   Provider enrollment   Network development and management   Quality management and improvement   Utilization and care management   Special investigations and waste, fraud and abuse detection   Behavioral and physical health   Information systems   Performance data reporting and encounter claims submission   Claims payments   Grievances and appeals