Common use of Administrative and Organizational Structure Clause in Contracts

Administrative and Organizational Structure. The Contractor shall have in place an organizational and operational structure capable of fulfilling all Contract requirements. This structure must support collection and integration of data across the Contractor’s delivery system and internal functional units to accurately report the Contractor’s performance. The Contractor must have in place sufficient administrative and clinical staff and organizational components to achieve compliance with Contract requirements and performance standards. The Contractor must 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 management;  Clinical assessment, disease management, care management and complex case management;  Behavioral and physical health;  Information systems;  Performance data reporting and encounter claims submission;  Claims payments; and  Grievances and appeals.

Administrative and Organizational Structure. The Contractor shall have in place an organizational and operational structure capable of fulfilling all Contract requirements. This structure must support collection and integration of data across the Contractor’s delivery system and internal functional units to accurately report the Contractor’s performance. The Contractor must have in place sufficient administrative and clinical staff and organizational components to achieve compliance with Contract requirements and performance standards. The Contractor must 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;  EXHIBIT 1 SCOPE OF WORK • Utilization management;  • Clinical assessment, disease management, care management and complex case management;  • Behavioral and physical health;  • Information Technology systems;  • Performance data reporting and encounter claims submission;  • Claims payments; and  • Grievances and appeals.

Administrative and Organizational Structure. The Contractor shall have in place an organizational and operational structure capable of fulfilling all Contract requirements. This structure must support collection and integration of data across the Contractor’s delivery system and internal functional units to accurately report the Contractor’s performance. The Contractor must have in place sufficient administrative and clinical staff and organizational components to achieve compliance with Contract requirements and performance standards. The Contractor must 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 management;  Clinical assessment, disease management, care management and complex case management;  Behavioral and physical health;  Information systems;  Performance data reporting and encounter claims submission;  Claims payments; and  Grievances and appeals.;

Administrative and Organizational Structure. The Contractor shall have in place an organizational and operational structure capable of fulfilling all Contract requirements. This structure must support collection and integration of data across the Contractor’s delivery system and internal functional units to accurately report the Contractor’s performance. The Contractor must have in place sufficient administrative and clinical staff and organizational components to achieve compliance with Contract requirements and performance standards. The Contractor must 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 management;  • Clinical assessment, disease management, care management and complex case management;  • Behavioral and physical health;  • Information systems;  • Performance data reporting and encounter claims submission;  • Claims payments; and  • Grievances and appeals.

Administrative and Organizational Structure. The Contractor shall have in place an organizational and operational structure capable of fulfilling all Contract requirements. This structure must support collection and integration of data across the Contractor’s delivery system and internal functional units to accurately report the Contractor’s performance. The Contractor must have in place sufficient administrative and clinical staff and organizational components to achieve compliance with Contract requirements and performance standards. The Contractor must 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; EXHIBIT 1 SCOPE OF WORK  Utilization management;  Clinical assessment, disease management, care management and complex case management;  Behavioral and physical health;  Information Technology systems;  Performance data reporting and encounter claims submission;  Claims payments; and  Grievances and appeals.