Compliance and Participation Sample Clauses

Compliance and Participation. 1. Practitioner shall be bound by and comply with the provisions of applicable state and federal laws and regulations. 2. Upon request, Practitioner shall participate in, and cooperate with OhioHealthy’s credentialing and recredentialing requirements and such other activities as OhioHealthy or its designee deems reasonably necessary in connection with its efforts to obtain and maintain NCQA, JCAHO, and/or appropriate accreditation, including without limitation, periodic site reviews of offices, records, premises and operations of Practitioner. 3. Practitioner shall comply with the requirements of, and shall participate in, such Quality Management and Utilization Management programs developed or implemented by OhioHealthy or a Payor (as agreed to by OhioHealthy), as such programs may be clarified, amended or supplemented from time to time, and the decisions, rules and regulations established under such programs, including without limitation, precertification of elective admissions and procedures, referral processes and reporting of clinical encounter data. 4. Practitioner shall comply with the requirements of, and shall participate in a Performance Improvement Plan developed or implemented by OhioHealthy or a Payor’s designee (as agreed to by OhioHealthy), following written notice to Practitioner of a failure to meet OhioHealthy’s or Payor’s standards for quality or utilization in the delivery of Covered Services as described in the applicable sections of the Ohio Revised Code. 5. Practitioner shall accept those compensation arrangements and rates set forth in this Agreement and/or the Program Attachment (or Payor or OhioHealthy supplied supplemental materials) as payment in full for those Covered Services rendered by Practitioner to Beneficiaries for those Programs in which Practitioner is a Participating Practitioner. OhioHealthy shall not be liable to Practitioner for any amounts a Payor fails to pay to Practitioner for Covered Services rendered by Practitioner. Practitioner shall hold harmless OhioHealthy against any claims for non-payment or under payment.

Compliance and Participation. 4.1.1 Physician shall use his/her best efforts to comply fully with and participate in the implementation of CCPA’s or the Payor’s (as applicable) written policies and programs as set forth in the Policy and Procedure Manual, to control the cost and utilization of health services that are consistent with sound medical practice and as described in the Product Descriptions, including but not limited to, written policies and programs regarding: (i) quality assurance; (ii) utilization management; (iii) claims payment review; (iv) beneficiary grievances; and (v) credentialing and re-credentialing. 4.1.2 Physician shall use his/her best efforts to abide by the determination under any policies and programs referred to in this Section 4.1 of CCPA or Payor (as applicable) on all such matters during the term of this Master Agreement and hereby waives any and all claims Physicians may have, now or in the future, against CCPA or any of its directors, officers, employees or agents arising out of such determinations with respect to Physician, provided that Physician does not hereby waive any claims resulting from the negligence, gross negligence or willful misconduct of CCPA or any of its directors, officers, employees or agents.

Compliance and Participation. Physician agrees to comply fully with and participate in the implementation of the Payer's and PHO’s policies and programs to control the cost and utilization of medical services as described in the Product Description, including, but not limited to, policies and programs regarding: (i) quality assurance; (ii) utilization management; (iii) claims payment review; (iv) Beneficiary grievances; and (v) minimum provider qualifications. In addition, Physician agrees to comply fully with and participate in the PHO's policies and programs, including, but not limited to, provider grievance and provider credentialing, recredentialing and sanctioning. Physician understands that credentialing criteria may vary between Products and/or Payers. Physician agrees to abide by the determination of the PHO or Payer (as applicable) on all such matters during the term of this Agreement and hereby waives any and all claims Physician may have, now or in the future, against the PHO or any of its directors, officers, employees or agents arising out of such determinations with respect to Physician. The PHO agrees to furnish Physician with a confidential profile as to his/her practice patterns on a regular basis. Physician agrees not to discriminate in the provision of health care services to Beneficiaries due to the Beneficiary's race, color, national origin, ancestry, religion, health status, sex, marital status, age or source of payment.

Compliance and Participation. Pharmacy shall comply fully with and be bound by the Participation Criteria described in the PARTICIPATION CRITERIA SCHEDULE (attached hereto and made a part hereof), the Provider Policies and Services Manual, and shall also abide by the rules, policies and procedures that Company has and will establish, including but not limited to, those regarding (a) quality improvement/management; (b) utilization management; (c) claims payment review;