Practice Guidelines. 4.12.7.1 The Contractor shall adopt a minimum of three (3) evidence-based clinical practice guidelines. Such guidelines shall: · Be based on the health needs and opportunities for improvement identified as part of the QAPI program; · Be based on valid and reliable clinical evidence or a consensus of Health Care Professionals in the particular field; · Consider the needs of the Members; · Be adopted in consultation with network Providers; and · Be reviewed and updated periodically as appropriate. 4.12.7.2 The Contractor shall submit all Practice Guidelines in use, which shall include a methodology for measuring and assessing compliance, to DCH for review and prior approval as part of the QAPI program plan as updated. 4.12.7.3 The Contractor shall disseminate the guidelines to all affected Providers and, upon request, to Members. 4.12.7.4 The Contractor shall ensure that decisions for Utilization Management, Member education, coverage of services, and other areas to which the guidelines apply are consistent with the guidelines. 4.12.7.5 In order to ensure consistent application of the guidelines the Contractor shall encourage Providers to utilize the guidelines, and shall measure compliance with the guidelines, until ninety percent (90%) or more of the Providers are consistently in compliance. The Contractor may use Provider incentive strategies to improve Provider compliance with guidelines.
Appears in 2 contracts
Samples: Contract for Provision of Services (Wellcare Health Plans, Inc.), Contract (Centene Corp)
Practice Guidelines. 4.12.7.1 The Contractor shall adopt a minimum of three (3) evidence-based clinical practice guidelines. Such guidelines shall: · • Be based on the health needs and opportunities for improvement identified as part of the QAPI program; · • Be based on valid and reliable clinical evidence or a consensus of Health Care Professionals in the particular field; · • Consider the needs of the Members; · • Be adopted in consultation with network Providers; and · • Be reviewed and updated periodically as appropriate.
4.12.7.2 The Contractor shall submit all Practice Guidelines in use, which shall include a methodology for measuring and assessing compliance, to DCH for review and prior approval as part of the QAPI program plan as updated.
4.12.7.3 The Contractor shall disseminate the guidelines to all affected Providers and, upon request, to Members.
4.12.7.4 The Contractor shall ensure that decisions for Utilization Management, Member education, coverage of services, and other areas to which the guidelines apply are consistent with the guidelines.
4.12.7.5 In order to ensure consistent application of the guidelines the Contractor shall encourage Providers to utilize the guidelines, and shall measure compliance with the guidelines, until ninety percent (90%) or more of the Providers are consistently in compliance. The Contractor may use Provider incentive strategies to improve Provider compliance with guidelines.
Appears in 2 contracts
Samples: Contract for Provision of Services, Contract for Provision of Services (Wellcare Health Plans, Inc.)
Practice Guidelines. 4.12.7.1 The Contractor shall adopt a minimum of three (3) evidence-based clinical practice guidelines. Such guidelines shall: · Be based on the health needs and opportunities for improvement identified as part of the QAPI program; · Be based on valid and reliable clinical evidence or a consensus of Health Care Professionals in the particular field; · Consider the needs of the Members; · Be adopted in consultation with network Providers; and · Be reviewed and updated periodically as appropriate.
4.12.7.2 The Contractor shall submit all the Practice Guidelines in useGuidelines, which shall include a methodology for measuring and assessing compliance, to DCH for review and prior approval as part of the QAPI program plan as updated.
4.12.7.3 The Contractor shall disseminate the guidelines to all affected Providers and, upon request, to Members.
4.12.7.4 The Contractor shall ensure that decisions for Utilization Management, Member education, coverage of services, and other areas to which the guidelines apply are consistent with the guidelines.
4.12.7.5 In order to ensure consistent application of the guidelines the Contractor shall encourage Providers to utilize the guidelines, and shall measure compliance with the guidelines, until ninety percent (90%) or more of the Providers are consistently in compliance. The Contractor may use Provider incentive strategies to improve Provider compliance with guidelines.
Appears in 2 contracts
Samples: Contract for Provision of Services (Centene Corp), Contract (Wellcare Health Plans, Inc.)