Performance of Member Assessments Sample Clauses

Performance of Member Assessments. For those Target Members for whom an encounter with their primary care provider is unable to be facilitated, and for whom a face-to-face assessment has been able to be arranged, Inovalon’s subcontracted physicians or physician extenders, as defined by CMS technical specifications (the “Member Assessor”) will perform face-to-face, member assessments of such Target Members and document such member’s active disease and co-morbidities (the “Face-To-Face Member Assessment” and the documentation of such, the “Member Assessment SOAP Note”)). Prior to targeting an HMO member for a Face-To-Face Member Assessment, Inovalon will provide a list of potential targets to Client in writing for approval. Client will approve or reject such targets in writing within 10 business days of receipt of the list of potential targets. Once Client approves any potential target, Inovalon is deemed authorized to outreach to each such Target Member in accordance with this Section 6(c) and Client will not rescind such authorization unless requested by the Target Member. The Face-To-Face Member Assessments shall be guided by information and data known by Inovalon regarding such member, as enabled by Inovalon’s Electronic Patient Assessment Solution Suite (ePASS) and data-driven health risk assessment technology (SmartHRA), and shall include, with respect to the Target Member, the following as appropriate: 1. Medical history (including chief complaint (CC), history of present illness (HPI), review of systems (ROS), past medical history (PMH), social history, family history and medications); 2. Physical exam (which shall generally include such segments as: general exam, eyes, ENT, neck, respiratory, cardiovascular, chest, abdominal, musculoskeletal, neurological, psychiatric, skin, and other such segments, as may change from time to time); 3. Diagnostics (as warranted and reasonably available, examples include pulse ox, ABIs, etc.); and 4. Assessment of current and chronic conditions. While the results of the Face-To-Face Member Assessment (i.e., the Member Assessment Encounter SOAP Note) are conveyed to Client and designated primary care provider, acknowledging that it is not the intention of the Face-To-Face Member Assessment to replace or supersede any primary care provider relationship, the Member Assessor shall render no management or treatment to the Target Member. The generality of the preceding sentence notwithstanding, in the event that the Member Assessor believes that the Target ...