Common use of HOOSIER HEALTHWISE SCOPE OF WORK Clause in Contracts

HOOSIER HEALTHWISE SCOPE OF WORK. Prior to the Contract effective date, FSSA will provide a series of orientation sessions to assist the Contractor in developing its internal operations to support the requirements of the Contract (i.e., data submission, data transmissions, reporting formats, etc.). The Contractor shall have in place sufficient administrative and clinical staff and organizational components to comply with all Hoosier Healthwise program requirements and standards. The Contractor shall manage the functional linkage of the following major operational areas:  Administrative and fiscal management  Member services  Provider services  Marketing  Provider enrollment  Network development and management  Quality management and improvement  Utilization and care management  Special investigations and waste, fraud and abuse detection  Behavioral and physical health  Information systems  Performance data reporting and encounter claims submission  Claims payments  Grievances and appeals