Common use of Departmental Monitoring Clause in Contracts

Departmental Monitoring. A. The Contractor shall cooperate with the Department and the Department's authorized representatives in the Department's monitoring of the Contractor's and Network Providers’ compliance with the requirements specified in this Agreement, the Contractor's and Network Providers’ performance as it relates to Participant Outcomes and consistency of quality indicators (see Appendix K), and the Department’s monitoring of the performance of the Contractor in at least the following areas: 1. Administration and management. 2. Complaint and Grievance systems. 3. Claims management. 4. Participant materials and customer services. 5. Finance, including Medical Loss Ratio reporting. 6. Information systems, including encounter data reporting.

Departmental Monitoring. A. The Contractor shall cooperate with the Department and the Department's authorized representatives in the Department's monitoring of the Contractor's and Network Providers’ compliance with the requirements specified in this Agreement, the Contractor's and Network Providers’ Provider's performance as it relates to Participant Outcomes and consistency of quality indicators (see Appendix K), and the Department’s monitoring of the performance of the Contractor in at least the following areas: 1. Administration and management. 2. Complaint and Grievance systems. 3. Claims management. 4. Participant materials and customer services. 5. Finance, including Medical Loss Ratio reporting. 6. Information systems, including encounter data reporting.

Departmental Monitoring. A. The Contractor shall cooperate with the Department and the Department's authorized representatives in the Department's monitoring of the Contractor's and Network Providers’ compliance with the requirements specified in this Agreement, the Contractor's and Network Providers’ Provider's performance as it relates to Participant Outcomes and consistency of quality indicators (see Appendix K), and the Department’s monitoring of the performance of the Contractor in at least the following areas: 1. Administration and management. 2. Complaint and Grievance systems. 3. Claims management. 4. Participant materials and customer services. 5. Finance, including Medical Loss Ratio reporting. 6. Information systems, including encounter data reporting.