Administrative Performance Program Sample Clauses

Administrative Performance Program a. The Administrative Performance (AP) Standard utilizes the AP Withhold (APW) methodology described in this section. The APW methodology requires the submission of Valid Encounter Data, including pharmacy claims data that is submitted to OHA and certified in accordance with OAR 410-141-3430 and that is also submitted to the All Payer All Claims database by OHA or by Contractor. OHA may provide further instructions about the APW process. The APW process will not alter OHA’s authority to administer the encounter data requirements of OAR 410-141-3430 or any other provisions under the Contract.
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Administrative Performance Program. Valid Encounter Claims Data‌ In order to ensure the integrity of the Medicaid program, OHA and CMS require compliance with a wide range of obligations relating to the verification of services provided to Members. One means by which compliance is verified is the collection and reporting data relating to claims for all services provided to Members, whether such claims are for Covered Services or other health-related services. Accordingly, Contractor is required, pursuant to 42 CFR §438.604, 42 CFR §438.606, and OAR 410-141-3430 to submit and certify to OHA the accuracy and truthfulness of Encounter Data, which is then subject to OHA for review and verification. In addition to ensuring the integrity of the Medicaid program, OHA also relies on Encounter Data to: (i) set Capitation Rates, (ii) calculate Quality Incentive Payments, and
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Administrative Performance Program. Valid Encounter Claims Data The terms and conditions of Section 10, Exhibit B, Part 8 in the Medicaid Contract are incorporated by reference and have the same force and effect as though they are fully set forth herein.
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Related to Administrative Performance Program

  • Ongoing Performance Measures The Department intends to use performance-reporting tools in order to measure the performance of Contractor(s). These tools will include the Contractor Performance Survey (Exhibit H), to be completed by Customers on a quarterly basis. Such measures will allow the Department to better track Vendor performance through the term of the Contract(s) and ensure that Contractor(s) consistently provide quality services to the State and its Customers. The Department reserves the right to modify the Contractor Performance Survey document and introduce additional performance-reporting tools as they are developed, including online tools (e.g. tools within MFMP or on the Department's website).

  • Employee Performance Review When a formal review of an employee’s performance is made, the employee concerned shall be given an opportunity to discuss, sign and make written comments on the review form in question and the employee is to receive a signed copy to indicate that its contents have been read. An employee shall be entitled to a minimum of two (2) work days to review the performance review prior to providing any response to the Employer, verbally or in writing, with respect to the evaluation.

  • Employee Performance Evaluations Any employee performance evaluation shall be prepared by the employee's supervisor who has the responsibility and authority to prepare such reports. Employee performance evaluation reports shall be discussed with the employee prior to finalization of each category of the report. An employee will receive an appointment with his/her department's reviewing officer to discuss the evaluation by signing the evaluation form in the space provided. Each department shall make a reasonable effort to ensure that the reviewing officer for this purpose has not been a party to the preparation of the evaluation. In no case shall the reviewing officer sign the evaluation form until a review has occurred. Any regular or special evaluation with a rating of "unsatisfactory" shall include plans for employee development. Except in cases of termination, release from probation, or leave of absence, employees who receive an unsatisfactory performance evaluation must receive a follow-up evaluation. The follow-up evaluation shall cover a period of time no greater than ninety (90) calendar days from the date of the final review of the initial unsatisfactory evaluation. An employee shall have the right to submit written comments regarding any evaluation and to have such comments included in his/her personnel file along with the evaluation.

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