PROVIDER APPLICATION REVIEW PROCESS Sample Clauses

PROVIDER APPLICATION REVIEW PROCESS. 31 a. All credentialing and re-credentialing applications shall be reviewed by
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PROVIDER APPLICATION REVIEW PROCESS a. All credentialing and re-credentialing applications shall be reviewed by CONTRACTOR. Providers with identified adverse issues shall be asked to provide a written explanation prior to CONTRACTOR review. In addition, CONTRACTOR shall maintain P&Ps for altering the conditions of the practitioner’s participation in the network based on issues of the quality of care and service that may arise after completing the credentialing process. Such P&Ps shall be provided to ADMINISTRATOR, upon request. Decisions to alter or terminate a provider’s participation in the network shall be made by CONTRACTOR. Providers with identified quality of care or service concerns shall be presented to the Peer Review Committee established by CONTRACTOR. Providers shall be advised in advance of the identified problems and shall be invited to respond in writing to the issues to go before the Peer Review Committee. The provider’s response, along with any additional documentation supplied by CONTRACTOR, shall be reviewed by the Peer Review Committee. The Peer Review Committee may recommend that no action be taken, that the provider be issued a Corrective Action Plan, or that the provider be terminated from the network. b. CONTRACTOR shall provide notice and a fair hearing to CONTRACTOR’s Network Providers, as required under applicable state and federal law, or at the discretion of CONTRACTOR’s Medical Director, in any case in which action is proposed to be taken by CONTRACTOR to restrict, suspend or terminate the Network Provider’s ability to provide health care services to Beneficiaries for reasons relating to deficiencies in quality of care, professional competence, or professional conduct which affects or could adversely affect the health, safety or welfare of any Beneficiaries and/or is reasonably likely to be detrimental to the delivery of quality care. If CONTRACTOR takes adverse action against a provider based on a quality-of-care issue, CONTRACTOR shall report as required by state and federal agencies and as required by the NPDB. c. ADMINISTRATOR shall be notified of any providers required to submit a Corrective Action Plan, or terminated as the result of a quality-of-care issue, within fourteen (14) calendar days of such action. The quality-of-care issue shall also be summarized and included with the notification.
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PROVIDER APPLICATION REVIEW PROCESS. 20 a. All credentialing and re-credentialing applications shall be reviewed by 21 CONTRACTOR. Providers with identified adverse issues shall be asked to provide a written 22 explanation prior to CONTRACTOR review. In addition, CONTRACTOR shall maintain P&Ps for 23 altering the conditions of the practitioner’s participation in the network based on issues of the quality of 24 care and service that may arise after completing the credentialing process. Such P&Ps shall be provided 25 to ADMINISTRATOR, upon request. Decisions to alter or terminate a provider’s participation in the 26 network shall be made by CONTRACTOR. Providers with identified quality of care or service 27 concerns shall be presented to the Peer Review Committee established by CONTRACTOR. Providers 28 shall be advised in advance of the identified problems and shall be invited to respond in writing to the 29 issues to go before the Peer Review Committee. The provider’s response, along with any additional 30 documentation supplied by CONTRACTOR, shall be reviewed by the Peer Review Committee. The 31 Peer Review Committee may recommend that no action be taken, that the provider be issued a 32 Corrective Action Plan, or that the provider be terminated from the network. 33 b. CONTRACTOR provides for notice and a fair hearing to CONTRACTOR’s Network 34 Providers, as required under applicable state and federal law, or at the discretion of CONTRACTOR’s 35 Medical Director in any case in which action is proposed to be taken by CONTRACTOR to restrict, 36 suspend or terminate the Network Provider’s ability to provide health care services to CONTRACTOR 37 Beneficiaries for reasons relating to deficiencies in quality of care, professional competence, or 1 professional conduct which affects or could adversely affect the health, safety or welfare of any 2 Beneficiaries and/or is reasonably likely to be detrimental to the delivery of quality care. If
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PROVIDER APPLICATION REVIEW PROCESS. 3 a. All credentialing and re-credentialing applications shall be reviewed by 4 CONTRACTOR. Providers with identified adverse issues shall be asked to provide a written explanation 8 shall be presented to the Peer Review Committee established by CONTRACTOR. Providers shall be 9 advised in advance of the identified problems and shall be invited to respond in writing to the issues to go 10 before the Peer Review Committee. The provider’s response, along with any additional documentation supplied by CONTRACTOR, shall be reviewed by the Peer Review Committee. The Peer Review 11 Committee may recommend that no action be taken, that the provider be issued a Corrective Action Plan, 12 or that the provider be terminated from the network. 16 affects or could adversely affect the health, safety or welfare of any Beneficiaries and/or is reasonably 18 provider based on a quality of care issue, CONTRACTOR shall report as required by state and federal agencies and as required by the NPDB.
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Related to PROVIDER APPLICATION REVIEW PROCESS

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  • Claims Review Population A description of the Population subject to the Claims Review.

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  • Timeliness of Submitting Orders You are obliged to date and indicate the time of receipt of all orders you receive from your customers and to transmit promptly all orders to us in time to provide for processing at the price next determined after receipt by you, in accordance with the Prospectuses. You are not to withhold placing with us orders received from any customers for the purchase of shares. You shall not purchase shares through us except for the purpose of covering purchase orders already received by you, or for your bona fide investment.

  • Review Protocol A narrative description of how the Claims Review was conducted and what was evaluated.

  • ADB’s Review of Procurement Decisions 11. All contracts procured under international competitive bidding procedures and contracts for consulting services shall be subject to prior review by ADB, unless otherwise agreed between the Borrower and ADB and set forth in the Procurement Plan.

  • Maintenance of Review Materials It will maintain copies of any Review Materials, Review Reports and other documents relating to a Review, including internal correspondence and work papers, for a period of at least two years after any termination of this Agreement.

  • AUDIT REVIEW PROCEDURES Any dispute concerning a question of fact arising under an interim or post audit of this AGREEMENT that is not disposed of by agreement, shall be reviewed by ALAMEDA CTC’s Deputy Executive Director of Finance and Administration. Not later than thirty (30) calendar days after issuance of the final audit report, CONSULTANT may request a review by ALAMEDA CTC’s Deputy Executive Director of Finance and Administration of unresolved audit issues. The request for review will be submitted in writing. Neither the pendency of a dispute nor its consideration by ALAMEDA CTC will excuse CONSULTANT from full and timely performance, in accordance with the terms of this AGREEMENT. CONSULTANT and subconsultants’ contracts, including cost proposals and ICRs, may be subject to audits or reviews such as, but not limited to, an AGREEMENT Audit, an Incurred Cost Audit, an ICR Audit, or a certified public accountant (“CPA”) ICR Audit Workpaper Review. If selected for audit or review, the AGREEMENT, cost proposal and ICR and related workpapers, if applicable, will be reviewed to verify compliance with 48 CFR, Chapter 1, Part 31 and other related laws and regulations. In the instances of a CPA ICR Audit Workpaper Review it is CONSULTANT’s responsibility to ensure federal, state, or local government officials are allowed full access to the CPA’s workpapers including making copies as necessary. The AGREEMENT, cost proposal, and ICR shall be adjusted by CONSULTANT and approved by ALAMEDA CTC to conform to the audit or review recommendations. CONSULTANT agrees that individual terms of costs identified in the audit report shall be incorporated into the contract by this reference if directed by ALAMEDA CTC at its sole discretion. Refusal by CONSULTANT to incorporate audit or review recommendations, or to ensure that the federal, state, or local governments have access to CPA workpapers, will be considered a breach of contract terms and cause for termination of the AGREEMENT and disallowance of prior reimbursed costs.

  • Asset Representations Review Process Section 3.01 Asset Representations Review Notices and Identification of Review Receivables. On receipt of an Asset Representations Review Notice from the Seller according to Section 5.7 of the Receivables Purchase Agreement, the Asset Representations Reviewer will start an Asset Representations Review. The Servicer will provide the list of Review Receivables to the Asset Representations Reviewer promptly upon receipt of the Asset Representations Review Notice. The Asset Representations Reviewer will not be obligated to start, and will not start, an Asset Representations Review until an Asset Representations Review Notice and the related list of Review Receivables is received. The Asset Representations Reviewer is not obligated to verify (i) whether the conditions to the initiation of the Asset Representations Review and the issuance of an Asset Representations Review Notice described in Section 7.6 of the Indenture were satisfied or (ii) the accuracy or completeness of the list of Review Receivables provided by the Servicer.

  • Claims Review Report The IRO shall prepare a Claims Review Report as described in this Appendix for each Claims Review performed. The following information shall be included in the Claims Review Report for each Discovery Sample and Full Sample (if applicable).

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