Provider Feedback. The MCO must have the administrative capacity to offer feedback to individual providers on the provider’s adherence to evidence-based practice guidelines, and positive and negative care variances from standard clinical pathways that may impact outcomes or costs. The MCO must use this information to guide MCO activities, such as performance improvement projects for providers that include incentive programs, or the development of QI programs. The MCO must collaborate with ODM and the SPBM on prescriber engagement strategies to educate and monitor the MCO's network providers regarding compliance with ODM’s preferred drug list, prior authorization requirements, billing requirements, and appropriate prescribing practices. The MCO must address noncompliance as it relates to adherence to the preferred drug list, failing to comply with prior authorization requirements, or operating outside industry or peer norms for prescribing practices.
Appears in 5 contracts
Samples: Baseline Provider Agreement, Baseline Provider Agreement, Baseline Provider Agreement
