Common use of Delegation of Certain Functions Clause in Contracts

Delegation of Certain Functions. If qualified, as determined by FHS, PPG shall accept delegation of and perform such utilization management, quality improvement, credentialing and recredentialing, Member grievance and appeal, medical record review, and capitation and claims adjudication functions, in accordance with the performance standards and criteria of FHS as set forth in the Operations Manual. PPG shall ensure the timely payment of Covered Services rendered by referral health professionals and shall perform such claims processing in accordance with applicable Benefit Program and Operations Manual.

Delegation of Certain Functions. If qualified, as determined by FHS, PPG shall accept delegation of and perform such utilization management, quality improvement, credentialing and recredentialing, Member grievance and appeal, medical record review, and capitation and claims adjudication functions, as further described in the Operations Manual and in accordance with the performance standards and criteria of FHS as set forth in the Operations Manual. PPG shall ensure the timely payment of Covered Services rendered by referral health professionals and shall perform such claims processing in accordance with applicable Benefit Program and Operations Manual.

Delegation of Certain Functions. If qualified, as determined by FHS, PPG shall accept delegation of and perform such utilization management, quality improvement, credentialing and recredentialing, . Member grievance and appeal, medical record review, and capitation and claims adjudication functions, in accordance with the performance standards and criteria of FHS as set forth in the Operations Manual. PPG shall ensure the timely payment of Covered Services rendered by referral health professionals and shall perform such claims processing in accordance with applicable Benefit Program and Operations Manual.