Bundled Services Program Sample Clauses

Bundled Services Program. Contractor shall make available to Members and shall administer the Bundled Services Program as follows: a. Contractor shall facilitate the delivery of Bundled Services to Members in order to reduce waste and improve quality of care. Bundled Services shall not include any surgical or medical procedures that are excluded under the Department’s health plans. b. Contractor shall maintain a network of providers capable of providing the Bundled Services offered in the Bundled Services Program. c. An Enrollee’s eligibility for a Reward Payment is based on the Member’s use of the Bundled Service. Reward Payment will be disbursed after adjudication of the claim for the Bundled Service. d. Contractor, upon approval from the Department, shall determine the methodology(ies) for determining the quality of a healthcare provider or facility from reliable, industry- accepted sources. e. Contractor shall determine cost savings to the State for a Bundled Service and the Reward Payment due to Enrollees by utilizing the Department's claims data and other Department-approved information. f. Contractor shall adjudicate Claims associated with Members’ receipt of a Bundled Service. g. Contractor shall notify the Department of the determined Reward Payment for each Enrollee on a frequency approved by the Department. Contractor shall exchange Reward Payment data on a frequency and in a file format approved by the Department. h. Contractor shall identify the savings realized to the Enrollee and the State when the Member receives a Bundled Service. i. Contractor shall establish and use procedures and evidence-based standards to ensure that only high-quality health care providers provide Bundled Services. j. Contractor shall provide assistance to Members in accessing and coordinating care for Bundled Services. k. Contractor shall be responsible for program development and management, including updating cost and quality data available to Members. Contractor shall regularly monitor utilization and costs in order to develop, recommend, and implement enhancements to the Bundled Services Program. l. Contractor shall make available a toll-free telephone number and website that Members may access to obtain information about the Bundled Services Program. Contractor's customer service hours shall be on a schedule approved by the Department.
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Bundled Services Program. PG-15 Reward Contractor shall One-hundred percent Ongoing $250 per Reward Payment determine the amount of (100%) of all Reward Payment not validation the Reward Payment Payments must be validated validated within the within the Department- within the Department- Department- approved timeframe approved timeframe approved timeframe PG-16 Reward Contractor shall notify One-hundred percent Monthly $250 per Reward Payment the Department of the (100%) of all Reward Payment for which notification to amount of the Reward Payments must be reported the Contractor does the Department Payment within the to the Department within the not notify the Department-approved Department-approved Department within timeframe timeframe the Department- approved timeframe PG-17 Reward Payment notification to the Member Contractor shall send a confirmation notice to Enrollees for each Reward Payment that is earned Contractor shall notify Enrollees of earned Reward Payments within seven (7) Calendar Days of determining that a Reward Payment is owed to an Enrollee Quarterly $500 per percentage point below one- hundred percent (100%) PG-18 Utilization and engagement Contractor shall engage Members to receive Bundled Services A minimum of ten percent (10%) of eligible services shall go through the Bundled Services, measured on a dollar basis. Annually $2,500 per full percentage point below ten percent (10%) PG-19 Communications Plan 1) Contractor shall submit a comprehensive communications plan to the Department by September 1, 2018 2) Contractor shall be responsible for writing, printing, and distributing (electronically or by mail) Bundled Services Program materials based on a Department- approved communications plan 1) Comprehensive communications plan is due to the Department by September 1, 2018 2) One-hundred percent (100%) of all program materials must be completed and distributed in accordance with the Department-approved communications plan One-time measurement Ongoing 1) $500 for each Business Day that Contractor fails to timely provide the communications plan 2) $500 for every instance in which Contractor fails to comply with the Department- approved communications plan

Related to Bundled Services Program

  • Hosted Services 3.1 The Provider hereby grants to the Customer a worldwide, non-exclusive licence to use the Hosted Services for the business purposes of the Customer in accordance with the Documentation during the Term. 3.2 The Provider shall create an Account for the Customer and shall provide to the Customer login details for that Account to enable the Customer to configure and administer the Hosted Services and enable registration of Customer End Users. 3.3 Except to the extent expressly permitted in this Agreement or required by law on a non- excludable basis, the licence granted by the Provider to the Customer under Clause 3.1 is subject to the following prohibitions: (a) the Customer must not sub-license its right to use the Hosted Services; (b) the Customer must not make any alteration to the Platform; and (c) the Customer must not conduct or request that any other person conduct any load testing or penetration testing on the Platform or Hosted Services without the prior written consent of the Provider. 3.5 The Customer shall use reasonable endeavours, including appropriate organisational and technical measures relating to Account access details, to ensure that no unauthorised person may gain access to the Hosted Services using an Account. 3.6 The parties acknowledge and agree that Schedule 2 (Availability SLA) shall govern the availability of the Hosted Services. 3.7 The Customer must ensure that all persons using the Hosted Services with the authority of the Customer or by means of an Account comply with the Terms Of Use. 3.8 The Customer must not use the Hosted Services in any way that causes, or may cause, damage to the Hosted Services or Platform or impairment of the availability or accessibility of the Hosted Services. 3.9 The Customer must not use the Hosted Services: (a) in any way that is unlawful, illegal, fraudulent or harmful; or (b) in connection with any unlawful, illegal, fraudulent or harmful purpose or activity. 3.10 For the avoidance of doubt, the Customer has no right to access the software code (including object code, intermediate code and source code) of the Platform, either during or after the Term. 3.11 The Provider may suspend the provision of the Hosted Services if any amount due to be paid by the Customer to AWS for the benefit of the Provider under this Agreement is overdue, and the Provider has given to the Customer at least 30 days' written notice, following the amount becoming overdue, of its intention to suspend the Hosted Services on this basis.

  • Medical Services Plan Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. The City shall pay one hundred percent (100%) of the premiums required by the plan.

  • Program Services a) Personalized Care Practice agrees to provide to Program Member certain enhancements and amenities to professional medical services to be rendered by Personalized Care Practice to Program Member, as further described in Schedule 1 to these Terms. Upon prior written notice to Program Member, Personalized Care Practice may add or modify the Program Services set forth in Schedule 1, as reasonably necessary, and subject to such additional fees and/or terms and conditions as may be reasonably necessary. b) Program Member acknowledges that the Program Services are services that are not covered services under any insurance contract to which Program Member may be a party, including, without limitation, Medicare, and are not reimbursable by Program Member’s insurer, health plan or any governmental entity, including Medicare. Program Member agrees to bear sole financial responsibility for the Member Amenities Fee and agrees not to submit to Program Member’s insurer, health plan or governmental entity any xxxx, invoice or claim for payment or reimbursement of such Member Amenities Fee. c) Personalized Care Practice or its designated affiliate will separately charge Program Member or Program Member’s insurer, health plan or governmental entity for medical, clinical, diagnostic or therapeutic services rendered by Personalized Care Practice or its designated affiliate to Program Member, and Program Member may seek payment or reimbursement from Program Member’s insurer or health plan for any such service to the extent covered by Program Member’s insurer, health plan or governmental entity. d) Program Member understands, agrees and covenants that this Agreement is a service contract, and not a contract for insurance.

  • Products and Services General Information

  • Hosting Services 13.1 If Supplier or its subcontractor, affiliate or any other person or entity providing products or services under the Contract Hosts Customer Data in connection with an Acquisition, the provisions of Appendix 1, attached hereto and incorporated herein, apply to such Acquisition. 13.2 If the Hosting of Customer Data by Supplier or its subcontractor, affiliate or any other person or entity providing products or services under the Contract contributes to or directly causes a Data Breach, Supplier shall be responsible for the obligations set forth in Appendix 1 related to breach reporting requirements and associated costs. Likewise if such Hosting contributes to or directly causes a Security Incident, Supplier shall be responsible for the obligations set forth in Appendix 1, as applicable. 14 Change Management

  • Contracted Services PPG and Member Physicians shall render Contracted Services which are not PPG Capitated Services to Members covered under this Addendum B and shall be compensated on a fee-for-service basis at the rates set forth in Addendum E. PPG shall submit claims in accordance with the terms of this Agreement and State and federal law.

  • Third Party Products and Services Any third-party hardware, software and/or services that is delivered by ResMed for use either standalone or in conjunction with ResMed products and/or services, shall be subject to the third-party terms and conditions and/or license agreements between Customer and the third party. Such third-party hardware, software and/or services is provided by ResMed "AS IS," without any warranty of any kind. Any representations or warranties as to such hardware, software and/or services shall only be as granted by the applicable third parties, if any, that accompany such products and/or software and/or services. Any representations, warranties, or other similar obligations with respect to such third-party hardware, software and/or services flow directly from the third party to Customer and ResMed shall have no responsibility at all for any such representations, warranties, obligations or lack thereof.

  • Cloud Services You will not intentionally (a) interfere with other customers’ access to, or use of, the Cloud Service, or with its security; (b) facilitate the attack or disruption of the Cloud Service, including a denial of service attack, unauthorized access, penetration testing, crawling, or distribution of malware (including viruses, trojan horses, worms, time bombs, spyware, adware, and cancelbots); (c) cause an unusual spike or increase in Your use of the Cloud Service that negatively impacts the Cloud Service’s operation; or (d) submit any information that is not contemplated in the applicable Documentation.

  • Approved Services; Additional Services Registry Operator shall be entitled to provide the Registry Services described in clauses (a) and (b) of the first paragraph of Section 2.1 in the Specification 6 attached hereto (“Specification 6”) and such other Registry Services set forth on Exhibit A (collectively, the “Approved Services”). If Registry Operator desires to provide any Registry Service that is not an Approved Service or is a material modification to an Approved Service (each, an “Additional Service”), Registry Operator shall submit a request for approval of such Additional Service pursuant to the Registry Services Evaluation Policy at xxxx://xxx.xxxxx.xxx/en/registries/rsep/rsep.html, as such policy may be amended from time to time in accordance with the bylaws of ICANN (as amended from time to time, the “ICANN Bylaws”) applicable to Consensus Policies (the “RSEP”). Registry Operator may offer Additional Services only with the written approval of ICANN, and, upon any such approval, such Additional Services shall be deemed Registry Services under this Agreement. In its reasonable discretion, ICANN may require an amendment to this Agreement reflecting the provision of any Additional Service which is approved pursuant to the RSEP, which amendment shall be in a form reasonably acceptable to the parties.

  • Included Services If any services, functions, or responsibilities not specifically described in this Agreement are an inherent, necessary, or customary part of the Services or are required for proper performance or provision of the Services in accordance with this Agreement, such services, functions, or responsibilities are deemed to be included within the scope of the Services to be delivered for the Charges, as if such services, functions, or responsibilities were specifically described in this Agreement.

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