Common use of Contractor Notifications Clause in Contracts

Contractor Notifications. Pursuant to Section 5.8, the Contractor shall submit a Contractor Notifications Report that includes all DCH requested updated information within 10 days of verification; subsequently a quarterly summary must be provided that includes but is not limited to: · Relationship of Parties · Criminal Background · Confidentiality Requirements · Insurance Coverage · Payment Bond & Letter of Credit · Compliance with Federal Laws · Conflict of Interest and Contractor Independence · Drug Free Workplace · Business Associate Agreement · System Status · Key staff or Senior Level Management · Current Corporate and Local Organization Chart · Unclaimed Payments from the Prior Year 4.18.4.4 Utilization Management Report 4.18.4.4.1 Utilization Management Reports must include an analysis of data and identification of opportunities for improvement and follow up of the effectiveness of the intervention. Utilization data is to be reported based on claim data. The reports shall include specific data elements that are defined by DCH such that all CMOs are reporting a common data set. 4.18.4.4.2 The Contractor shall submit a Utilization Management Report on Utilization patterns and aggregate trend analysis. The Contractor shall also submit individual physician profiles to DCH, as requested. These Reports should provide to DCH analysis and interpretation of Utilization patterns, including but not limited to, high volume services, high risk services, services driving cost increases, including prescription drug utilization; Fraud and Abuse trends; and Quality and disease management. The Contractor shall provide ad hoc reports pursuant to the requests of DCH. The Contractor shall submit its proposed reporting mechanism, including but not limited to focus of study, data sources to DCH for approval. 4.18.4.4.3 The Contractor shall select three (3) of the following elements to monitor in its physician profiles. Each element should be measured against an established threshold. · Member access (encounters per member per year, new patient visit within 6 months, ER use per member per year, etc.) · Preventive care (EPSDT rates, breast cancer screening rates, immunizations, etc.) · Disease management (asthma ER/IP encounters, HBA1C rates, etc.) · Pharmacy utilization (generics, asthma medications, etc.)

Contractor Notifications. Pursuant to Section 5.8, the Contractor shall submit a Contractor Notifications Report that includes all DCH requested updated information within 10 days of verification; subsequently a quarterly summary must be provided that includes but is not limited to: · • Relationship of Parties · • Criminal Background · • Confidentiality Requirements · • Insurance Coverage · • Payment Bond & Letter of Credit · • Compliance with Federal Laws · • Conflict of Interest and Contractor Independence · • Drug Free Workplace · • Business Associate Agreement · • System Status · • Key staff or Senior Level Management · • Current Corporate and Local Organization Chart · • Unclaimed Payments from the Prior Year 4.18.4.4 Utilization Management Report Report 4.18.4.4.1 Utilization Management Reports must include an analysis of data and identification of opportunities for improvement and follow up of the effectiveness of the intervention. Utilization data is to be reported based on claim data. The reports shall include specific data elements that are defined by DCH such that all CMOs are reporting a common data set. . 4.18.4.4.2 The Contractor shall submit a Utilization Management Report on Utilization patterns and aggregate trend analysis. The Contractor shall also submit individual physician profiles to DCH, as requested. These Reports should provide to DCH analysis and interpretation of Utilization patterns, including but not limited to, high volume services, high risk services, services driving cost increases, including prescription drug utilization; Fraud and Abuse trends; and Quality and disease management. The Contractor shall provide ad hoc reports pursuant to the requests of DCH. The Contractor shall submit its proposed reporting mechanism, including but not limited to focus of study, data sources to DCH for approval. 4.18.4.4.3 The Contractor shall select three (3) of the following elements to monitor in its physician profiles. Each element should be measured against an established threshold. · Member access (encounters per member per year, new patient visit within 6 months, ER use per member per year, etc.) · Preventive care (EPSDT rates, breast cancer screening rates, immunizations, etc.) · Disease management (asthma ER/IP encounters, HBA1C rates, etc.) · Pharmacy utilization (generics, asthma medications, etc.)