Common use of Contract Management Philosophy Clause in Contracts

Contract Management Philosophy. 2.2.2.2.1. The Contractor shall develop and implement policies and procedures to ensure that all Medically Necessary Services are provided to Enrollees based on their individual needs and consistent with Appendix A and B. Such policies and procedures, including any updates to existing policies and procedures, shall be submitted to the Commonwealth for review upon request. 2.2.2.2.2. The Contractor shall manage all aspects of its One Care Plan line of business consistent with a data driven management philosophy, where decisions are made utilizing available data. Such data shall come from multiple sources including, claims and Encounter Data, authorization data, medical record reviews, Enrollee input, provider surveys, clinical outcomes data, Appeals, Grievances, sanctions and corrective action plans. The Contractor shall use data analysis and reports for management purposes for Network Management, Utilization Management, Care Management, Quality Management, and customer service responsibilities under this Contract.