Individual Case Management Sample Clauses

The Individual Case Management clause establishes procedures for handling specific cases or disputes on a one-on-one basis between the parties involved. Typically, this clause outlines how each case will be managed separately, detailing steps such as notification, documentation, and resolution processes tailored to the individual circumstances of each case. Its core practical function is to ensure that each issue is addressed independently, preventing group actions and promoting tailored solutions, thereby streamlining dispute resolution and reducing the risk of collective litigation.
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: 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 ▇▇▇▇▇ Bifida Amputations Paralytic Syndromes Major Head Trauma Severe ▇▇▇▇▇ 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.
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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
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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 (▇▇▇) ▇▇▇-▇▇▇▇ or ▇-▇▇▇-▇▇▇-▇▇▇▇. 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. 17.2 The Contractor will ensure that there will be dedicated resources to enable the smooth running of the Framework Agreement and a clear plan of contacts at various levels within the Contractor's organisation. Framework Public Bodies may look to migrate to this Framework Agreement as and when their current contractual arrangements expire. The Contractor will where necessary assign additional personnel to this Framework Agreement to ensure agreed service levels are maintained and to ensure a consistent level of service is delivered to all Framework Public Bodies. 17.3 In addition to annual meetings with the Authority's Strategic Contract Manager, the Contractor is expected to develop relationships with nominated individuals within each of the Framework Public Bodies to ensure that the level of service provided on a local basis is satisfactory. Where specific problems are identified locally, the Contractor will attempt to resolve such problems with the nominated individual within that organisation. The Authority's Strategic Contract Manager will liaise (or meet as appropriate) regularly with the Framework Public Bodies' Contract Manager, and where common problems are identified, it will be the responsibility of the Contractor to liaise with the Authority's Strategic Contract Manager to agree a satisfactory course of action. Where the Contractor becomes aware of a trend that would have a negative effect on one or more of the Framework Public Bodies, they should immediately notify the Authority's Strategic Contract Manager to discuss corrective action. 17.4 Regular meetings, frequency to be advised by Framework Public Body, will be held between the Framework Public Bodies' Contract Manager and the Contractor's representative to review the performance of their Call-Off Contract(s) under this Framework Agreement against the agreed service levels as measured through Key Performance Indicators (KPIs). Reports will be provided by the Contractor to the Framework Public Bodies' Contract Manager at least 14 days prior to the these meetings. 17.5 Performance review meetings will also be held annually, between the Authority's Strategic Contract Manager and the Contractor's representative to review the performance of the Framework Agreement against the agreed service levels as measured through Key Performance Indicators. A summary of the quarterly reports will be provided by the Contractor at least 14 days prior to these meetings. 17.6 The Authority will gather the outputs from contract management to review under the areas detailed in the table below. Provision of management reports 90% to be submitted within 10 working days of the month end Report any incident affecting the delivery of the Service(s) to the Framework Public Body 100% to be reported in writing to FPB within 24 hours of the incident being reported by telephone/email Prompt payment of sub-contractors and/or consortia members (if applicable). Maximum of 30 from receipt of payment from Framework Public Bodies, 10 days target 100% within 30 days

  • 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 ▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇.

  • Exit Management 58.1. The Service Provider shall perform its relevant Exit Management obligations as part of the Contract whether applicable on either the expiry or early termination of this Contract. 58.2. The Service Provider agrees that if it breaches (or attempts or threatens to breach) its obligation to provide Exit Management, the Purchaser and their respective customers and stakeholders shall be irreparably harmed. In such circumstance, the Service Provider agrees that the Purchaser may proceed directly to court notwithstanding anything to the contrary in the dispute resolution procedure outlined in Clause 53 (Dispute Resolution). If a court of competent jurisdiction finds that the Service Provider has breached (or attempted or threatened to breach) any such obligation, the Service Provider agrees that without any additional findings of irreparable injury, or other conditions to interdict, the Service Provider shall not oppose the entry of an appropriate order compelling performance by the Service Provider and restraining the Service Provider from any further breaches or attempted or threatened breaches of its obligations in relation to Exit Management. 58.3. A draft of the Exit Plan shall be produced by the Service Provider and supplied to the Purchaser within [three (3) months] after the Commencement Date and shall include or address the matters specified in Clause 59.3. The Purchaser shall provide to the Service Provider the Purchaser’s comments on the plan within one (1) month of the Purchaser’s receipt of the plan. The Service Provider shall take into account the comments and suggestions of the Purchaser and shall issue the final version of the Exit Plan to the Purchaser within ten (10) Working Days of receipt of the Authority’s comments. 58.4. The Service Provider shall throughout the period of the Contract review, maintain and continuously update the Exit Plan which shall include: 58.4.1. the activities required to enable the Purchaser to re-tender the Purchaser Requirements and/or the provision of the Services; 58.4.2. the activities necessary to support any Replacement Service Provider or the Purchaser in carrying out any necessary due diligence relating to all or part of the Services; 58.4.3. details of the Exit Management to be provided by the Service Provider prior to the Exit Management Date; 58.4.4. support for the Replacement Service Provider or the Purchaser during their preparation of any relevant plan for the transition of the System to the Replacement Service Provider or Purchaser, including prior to and during such transition period; 58.4.5. the maintenance of a ‘business as usual’ environment for the Purchaser during the period when Exit Management obligations are applicable; and 58.4.6. all other necessary activities to support the preparation for, and execution of, a smooth and orderly Exit Management and transfer of all or part of the Services to either a Replacement Service Provider or the Purchaser. 58.5. No amendment of the Exit Plan shall be made without prior written consent of the Purchaser.