External Review. The M+C Organization will have an agreement with an independent quality review and improvement organization (review organization) approved by CMS. [422.154(a)] (a) The agreement will be consistent with CMS guidelines and will: (i) Require that the M+C Organization allocate adequate space for use of the review organization whenever it is conducting review activities and provide all pertinent data, including patient care data, at the time the review organization needs the data to carry out the reviews and make its determinations, and (ii) Except in the case of complaints about quality, exclude review activities that CMS determines would duplicate review activities conducted as part of an accreditation process or as part of CMS monitoring. [422.154(b)]
Appears in 5 contracts
Samples: Contract With Eligible Medicare+choice Organization (Wellcare Health Plans, Inc.), Contract With Eligible Medicare+choice Organization (Wellcare Health Plans, Inc.), Contract With Eligible Medicare+choice Organization (Sierra Health Services Inc)
