Common use of Policies and Procedures; Provider Manual Clause in Contracts

Policies and Procedures; Provider Manual. QualCare and/or the applicable Payor shall establish policies and procedures, including but not limited to, UM and QM programs, credentialing, re-credentialing, and privileges standards, grievance and appeals procedures, and administrative procedures, as may be set forth in QualCare’s Provider Manual, as may be amended from time to time. To the extent that QualCare is responsible for providing UM or QM programs, QualCare shall establish appropriate medical committees to assure effective utilization and quality of care for Members. Such medical committees will assist QualCare in the development, implementation, and administration of QualCare’s UM and QM programs.