Common use of Network Provider Practice Guidelines, General Standards Clause in Contracts

Network Provider Practice Guidelines, General Standards. (A) The Contractor and its Network Providers shall develop or adopt practice guidelines consistent with current standards of care as recommended by professional groups such as the American Academy of Pediatric Dentistry. The practice guidelines shall meet the following requirements: (1) Guidelines shall be based on valid and reliable clinical evidence or a consensus of health care professionals in the particular field; (2) Guidelines shall consider the needs of the Contractor’s Dental Plan Enrollees; (3) Guidelines shall be adopted in consultation with providers; and (4) Guidelines shall be reviewed and updated periodically as appropriate. (B) The Contractor shall disseminate the practice guidelines to all affected Network Providers and, upon request, to Enrollees and Potential Enrollees. (C) The Contractor’s decisions for utilization management, Enrollee education, coverage of services, and other areas to which the guidelines apply are consistent with the practice guidelines.

Network Provider Practice Guidelines, General Standards. (A) The Contractor and its Network Providers shall develop or adopt practice guidelines consistent with current standards of care as recommended by professional groups such as the American Academy of Pediatric Dentistry. The practice guidelines shall meet the following requirements: (1) Guidelines shall be based on valid and reliable clinical evidence or a consensus of health care professionals in the particular field; (2) Guidelines shall consider the needs of the Contractor’s Dental Plan Enrollees; (3) Guidelines shall be adopted in consultation with providers; and (4) Guidelines shall be reviewed and updated periodically as appropriate. (B) The Contractor shall disseminate the practice guidelines to all affected Network Providers and, upon request, to Enrollees and Potential Enrollees. (C) The Contractor’s decisions for utilization management, Enrollee education, coverage of services, and other areas to which the guidelines apply are consistent with the practice guidelines.

Network Provider Practice Guidelines, General Standards. (A) The Contractor and its Network Providers shall develop or adopt practice guidelines consistent with current standards of care as recommended by professional groups such as the American Academy of Pediatric DentistryPediatrics and the U.S. Preventive Services Task Force. The practice guidelines shall meet the following requirements: (1) Guidelines shall be based on valid and reliable clinical evidence or a consensus of health care professionals in the particular field; (2) Guidelines shall consider the needs of the Contractor’s Dental Health Plan Enrollees; (3) Guidelines shall be adopted in consultation with providersNetwork Providers; and (4) Guidelines shall be reviewed and updated periodically as appropriate. (B) The Contractor shall disseminate the practice guidelines to all affected Network Providers and, upon request, to Enrollees and Potential Enrollees. (C) The Contractor’s decisions for utilization management, Enrollee education, coverage of services, and other areas to which the guidelines apply are consistent with the practice guidelines.