Evaluation Information. The Contractor shall develop and implement policies and procedures to ensure that health care professionals are regularly advised of information maintained by the Contractor to evaluate the performance or practice of health care professionals. The Contractor shall consult with health care professionals in developing methodologies to collect and analyze health care professional profiling data. The Contractor shall provide any such information and profiling data and analysis to health care professionals. Such information, data or analysis shall be provided on a periodic basis appropriate to the nature and amount of data and the volume and scope of services provided. Any profiling data used to evaluate the performance or practice of a health care professional shall be measured against stated criteria and an appropriate group of health care professionals using similar treatment modalities serving a comparable patient population. Upon presentation of such information or data, each health care professional shall be given the opportunity to discuss the unique nature of the health care professional's patient population which may have a bearing on the health care professional's profile and to work cooperatively with the Contractor to improve performance.
Appears in 8 contracts
Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)
Evaluation Information. The Contractor shall develop and implement policies and procedures to ensure that health care professionals Participating Providers are regularly advised of information maintained by the Contractor to evaluate the their performance or practice of health care professionalspractice. The Contractor shall consult with health care professionals in developing methodologies to collect and analyze health care professional Participating Providers profiling data. The Contractor shall provide any such information and profiling data and analysis to health care professionalsits Participating Providers. Such information, data or analysis shall be provided on a periodic basis appropriate to the nature and amount of data and the volume and scope of services provided. Any profiling data used to evaluate the performance or practice of a health care professional Participating Provider shall be measured against stated criteria and an appropriate group of health care professionals using similar treatment modalities serving a comparable patient population. Upon presentation of such information or data, each health care professional Participating Provider shall be given the opportunity to discuss the unique nature of the health care professional's his or her patient population which may have a bearing on the health care professionalParticipating Provider's profile and to work cooperatively with the Contractor to improve performance.
Appears in 2 contracts
Samples: Medicaid Managed Care Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Agreement (Amerigroup Corp)
Evaluation Information. The Contractor shall develop and implement policies and procedures to ensure that health care professionals are regularly advised of information maintained by the Contractor to evaluate the performance or practice of health care professionals. The Contractor shall consult with health care professionals in developing methodologies to collect and analyze health care professional profiling data. The Contractor shall provide any such information and profiling data and analysis to health care professionals. Such information, data or analysis shall be provided on a periodic basis appropriate to the nature and amount of data and the volume and scope of services provided. Any profiling data used to evaluate the performance or practice of a health care professional shall be measured against stated criteria and an appropriate group of health care professionals using similar treatment modalities serving a comparable patient population. Upon presentation of such information or data, each health care professional shall be given the opportunity to discuss the unique nature of the health care professional's patient population which may ma y have a bearing on the health care professional's profile and to work cooperatively with the Contractor to improve performance.
Appears in 1 contract
Evaluation Information. The Contractor shall develop and implement policies and procedures to ensure that health care professionals Participating Providers are regularly advised of information maintained by the Contractor to evaluate the their performance or practice of health care professionalspractice. The Contractor shall consult with health care professionals in developing methodologies to collect and analyze health care professional Participating Providers profiling data. The Contractor shall provide any such information and profiling data and analysis to health care professionalsits Participating Providers. Such information, data or analysis shall be provided on a periodic basis appropriate to the nature and amount of data and the volume and scope of services provided. Any profiling data used to evaluate the performance or practice of a health care professional Participating Provider shall be measured against stated criteria and an appropriate group of health care professionals using similar treatment modalities serving a comparable patient population. Upon presentation of such information or data, each health care professional Participating Provider shall be given the opportunity to discuss the unique nature of the health care professional's his or her patient population which may have a bearing on the health care professional's Participating Provider’s profile and to work cooperatively with the Contractor to improve performance.
Appears in 1 contract
Samples: Primary Care Partial Capitation Provider (Pcpcp) Medicaid Managed Care Model Contract
Evaluation Information. The Contractor shall develop and implement policies and procedures to ensure entire that health care professionals are regularly advised of information maintained by the Contractor to evaluate the performance or practice of health care professionals. The Contractor shall consult with health care professionals in developing methodologies to collect and analyze health care professional profiling data. The Contractor shall provide any such information and profiling data and analysis to health healthy care professionals. Such information, data or analysis shall be provided on a periodic basis appropriate to the nature and amount of data and the volume and scope of services provided. Any profiling data used to evaluate the performance or practice of a health care professional shall be measured against stated criteria and an appropriate group of health care professionals using similar treatment modalities serving a comparable patient population. Upon __ UPON presentation of such information or data, each health care professional shall be given the opportunity to discuss the unique UNIQUE nature of the health care professional's patient population which may have a bearing on the health care professional's profile and to work cooperatively with the Contractor to improve performance.
Appears in 1 contract
Samples: Medicaid Managed Care Model Contract (Amerigroup Corp)
Evaluation Information. The Contractor shall develop and implement policies and procedures to ensure that health care professionals are regularly advised of information maintained by the Contractor to evaluate the performance or practice of health care professionals. The Contractor shall consult with health care professionals in developing methodologies to collect and analyze health care professional profiling data. The Contractor shall provide any such information and profiling data and analysis to health care professionals. Such information, data or analysis shall be provided on a periodic basis appropriate to the nature and amount of data and the volume and scope of services provided. Any profiling data used to evaluate the performance or practice of a health care professional shall be measured against stated criteria and an appropriate group of health care professionals using similar treatment modalities serving a comparable patient population. Upon presentation of such information or data, each health care professional shall be given the opportunity to discuss the unique nature of the health care professional's patient population which may have a bearing on the health care professional's profile and to work cooperatively with the Contractor to improve performance.. FHPlus - Section 21 (PARTICIPATING PROVIDERS) October 1, 2001 21-4
Appears in 1 contract
Samples: Consultant Services Agreement (Wellcare Health Plans, Inc.)