CLINICAL SERVICE AND UTILIZATION MANAGEMENT Clause Samples
The Clinical Service and Utilization Management clause defines the responsibilities and procedures for overseeing the delivery and use of clinical services within a healthcare agreement. It typically outlines how medical necessity is determined, the process for authorizing treatments, and the criteria for reviewing the appropriateness of care provided to patients. This clause ensures that healthcare services are delivered efficiently and appropriately, helping to control costs and maintain quality by preventing unnecessary or excessive treatments.
CLINICAL SERVICE AND UTILIZATION MANAGEMENT. 1. Section 4.1.A.2 is hereby amended by striking the word “abuse”, and inserting the word “use”.
2. Section 4.1.B.4.c is hereby amended by striking the word “abuse”, and inserting the word “use”.
3. Section 4.1.B.4.d is hereby amended by striking the word “abuse”, and inserting the word “use”.
CLINICAL SERVICE AND UTILIZATION MANAGEMENT. 6. Section 4.13.C is hereby amended by adding at the end therein the following language: “unless otherwise specified by EOHHS.”
CLINICAL SERVICE AND UTILIZATION MANAGEMENT. A.2 is hereby amended by striking Subsections 4.3.A.2.(▇-▇) and adding at the end therein the following:
CLINICAL SERVICE AND UTILIZATION MANAGEMENT. 4. Section 4.13 is hereby amended by adding at the end therein the following:
CLINICAL SERVICE AND UTILIZATION MANAGEMENT. Administrative Requirements Overview