Individual Case Management Sample Clauses

Individual Case Management. Case Management is the process by which the Plan, in its sole discretion, identifies alternative treatment modalities commensurate with the Member’s diagnosis profile and consults with the patient and attending Professional Provider(s). Notwithstanding the foregoing, all decisions regarding the treatment to be provided to a Member shall remain the responsibility of the treating Professional Provider(s) and the Member working with the Plan. The Plan shall provide such alternative benefits, in its sole discretion, only when, and for so long as, it determines that the procedures/Services are Medically Necessary and Appropriate, cost effective, and that the total benefits paid for such procedures/Services do not exceed the total benefits to which the Member would otherwise be entitled under this Agreement in the absence of alternative benefits. The Plan will provide Individual Case Management Services for those Members identified by the Plan as falling into one (1) or more of the following diagnosis profiles of illnesses or injuries, or such other diagnosis profiles as deemed appropriate from time to time by the Plan: Illnesses Acquired Immune Deficiency Syndrome Cystic Fibrosis Amyotrophic Lateral Sclerosis Diabetes Mellitus Autism Spectrum Disorders Multiple Sclerosis Carcinoma Muscular Dystrophy Cardiac Surgery Neonatal High Risk Infants Cerebral Palsy Osteomyelitis Cerebrovascular Accident Psychiatric Diagnoses Chronic Obstructive Pulmonary Disease Sickle Cell Anemia Complications of Chronic Disease Processes Xxxxx Bifida Injuries Amputations Paralytic Syndromes Major Head Trauma Severe Xxxxx Multiple Fractures Spinal Cord Injury The Plan in its sole discretion, reserves the right to limit access and/or modify benefit(s) for any individual Member, regardless of disease or condition, when the Plan identifies utilization patterns that could potentially result in harm to such Member or the public.
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Individual Case Management. Group shall cooperate with HCT’s policies, which may be modified from time to time to comply with NCQA’s requirements, for identifying Members with complex or serious medical conditions, assessment of those conditions and establishment and implementation of a treatment plan appropriate for those conditions.
Individual Case Management. 21 In the event of a severe or long-term illness or injury, the service representative assists your network 22 provider in identifying treatment alternatives that offer cost-effective care and enhancements to quality 23 of life. 24 26 TRADITIONAL MEDICAL PLAN SUMMARY 27 OF COVERED MEDICAL SERVICES AND SUPPLIES 28 29 This summary applies to the Traditional Medical Plan. 30 31 Covered Services and Supplies 32 In general, the plan covers medically necessary services and supplies used to diagnose or treat

Related to Individual Case Management

  • Case Management Prompt resolution of any dispute is important to both parties; and the parties agree that the arbitration of any dispute shall be conducted expeditiously. The arbitrators are instructed and directed to assume case management initiative and control over the arbitration process (including scheduling of events, pre-hearing discovery and activities, and the conduct of the hearing), in order to complete the arbitration as expeditiously as is reasonably practical for obtaining a just resolution of the dispute.

  • Disease Management If you have a chronic condition such as asthma, coronary heart disease, diabetes, congestive heart failure, and/or chronic obstructive pulmonary disease, we’re here to help. Our tools and information can help you manage your condition and improve your health. You may also be eligible to receive help through our care coordination program. This voluntary program is available at no additional cost you. To learn more about disease management, please call (000) 000-0000 or 0-000-000-0000. About This Agreement Our entire contract with you consists of this agreement and our contract with your employer. Your ID card will identify you as a member when you receive the healthcare services covered under this agreement. By presenting your ID card to receive covered healthcare services, you are agreeing to abide by the rules and obligations of this agreement. Your eligibility for benefits is determined under the provisions of this agreement. Your right to appeal and take action is described in Appeals in Section 5. This agreement describes the benefits, exclusions, conditions and limitations provided under your plan. It shall be construed under and shall be governed by the applicable laws and regulations of the State of Rhode Island and federal law as amended from time to time. It replaces any agreement previously issued to you. If this agreement changes, an amendment or new agreement will be provided.

  • Performance Management 17.1 The Contractor will appoint a suitable Account Manager to liaise with the Authority’s Strategic Contract Manager. Any/all changes to the terms and conditions of the Agreement will be agreed in writing between the Authority’s Strategic Contract Manager and the Contractor’s appointed representative.

  • Change Management BellSouth provides a collaborative process for change management of the electronic interfaces through the Change Control Process (CCP). Guidelines for this process are set forth in the CCP document as amended from time to time during this Agreement. The CCP document may be accessed via the Internet at xxxx://xxx.xxxxxxxxxxxxxxx.xxxxxxxxx.xxx.

  • Exit Management The Contractor shall perform its relevant Exit Management obligations as part of the Framework whether applicable on either the expiry or early termination of this Agreement.

  • Adaptive Management ‌ This CCAA is based on the principles of Adaptive Management set out in 65 Fed. Reg. at 35,242. The adaptive management process is a structured approach for dealing with uncertainty. The adaptive management process develops hypotheses regarding uncertainty and research to test those hypotheses in an iterative process to develop effective strategies for minimizing the uncertainty. The signatories to this CCAA agree and recognize that implementation of the Conservation Strategy objectives and criteria, Conservation Measures and Actions, and the Covered Area may change as new science emerges. The effectiveness of the Conservation Strategy objectives and criteria, Conservation Measures, Conservation Actions, monitoring methods, and new technologies will be reviewed by the Administrator on an annual basis, with input from the Adaptive Management Committee. The Adaptive Management Committee will be responsible for reviewing and evaluating the effectiveness of Conservation Program under the 2020 DSL CCAA as described in Sections 2.0 and 16.1, including the effectiveness and implementation of the Conservation Strategy, Conservation Measures and Conservation Actions; setting priorities for DSL Habitat conservation and monitoring habitat loss; and recommending changes to any aspect of the Conservation Program based on new science. As a result, appropriate modifications to the Conservation Measures and Actions may be incorporated to further refine the goals and objectives of this 2020 DSL CCAA. Such modifications are incorporated into existing CIs, if they were identified in changed circumstances in the 2020 DSL CCAA. Modifications not related to changed circumstances identified in the 2020 DSL CCAA and instead related to unforeseen circumstances may be incorporated into new CIs that take effect after the modifications have been made and to existing CIs only with written consent from the Participants and Service. Additionally, research projects that are designed to determine the effectiveness of management practices will be encouraged and utilized to determine what Adaptive Management is necessary. Changes resulting from Adaptive Management will flow through the Governance structure as described in Section 2.0 of this CCAA.

  • Time Management Because of the nature of the duties performed by these supervisors, it is impracticable to apply provisions which prescribe normal work hours. However, it is normally expected that eighty (80) hours of work shall constitute a normal payroll period. It is recognized that these supervisors are responsible for managing and accounting for their own hours of work and that they may work hours in excess of the normal work day and/or payroll period and may make adjustments in hours of work in subsequent work days and/or payroll periods, provided such time management system does not result in overtime payment or guarantee hour-for-hour time off for extra hours worked.

  • Traffic Management The Customer will not utilize the Services in a manner which, in the view of the Centre Operator, significantly distorts traffic balance on the Centre Operator’s circuits which are shared with other users. If, in the reasonable view of the Centre Operator, the Customer’s traffic patterns cause or may cause such distortion, the Customer should have a dedicated circuit capability. If the Customer declines to do so then the Centre Operator may suspend the Services while the matter is being resolved. If there is no resolution within 5 business days then either party may terminate the Agreement.

  • Attendance Management Days of absence arising out of a medically-established serious chronic condition, an ongoing course of treatment, a catastrophic event, absence for which WSIB benefits are payable, medically necessary surgical interventions, or days where the employee is asymptomatic and is under a doctor’s care from the commencement of symptoms for a confirmed communicable disease (and has provided medical substantiation of such symptoms) but is required to be absent under the Hospital or public health authority protocol, will not be counted for the purposes of being placed on, or progressing through, the steps of an attendance management program. Leaves covered under the Employment Standards Act, 2000 and leaves under Article 11 will not be counted for the purposes of being placed on, or progressing through, the steps of an attendance management program.

  • Crisis Management 1. The Parties reaffirm their commitment to cooperating in promoting international peace and stability.

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