Provider Participation/Cooperation with UR/QM Programs Sample Clauses

Provider Participation/Cooperation with UR/QM Programs. As applicable, PROVIDER agrees to participate in, cooperate and comply with, and abide by decisions of XXXXX, MCO, and/or Plan(s) with respect to XXXXX’, MCO’s, and/or Plan(s)’ medical policies and medical management programs, procedures or activities; quality improvement and performance improvement programs, procedures and activities; and utilization and management review; care coordination activities including, but not limited to, medical record reviews, HEDIS reporting, disease management programs, case management, clinical practice guidelines, and other quality measurements to improve Members’ care. PROVIDER further agrees to comply and cooperate with an independent quality review and improvement organization’s activities pertaining to the provision of Covered Services for Medicare, Medicare Advantage, and Medical Assistance Program Members. PROVIDER shall implement a continuous quality improvement action plan if areas for improvement are identified.

Provider Participation/Cooperation with UR/QM Programs. As applicable, PROVIDER agrees to participate in, cooperate and comply with, and abide by decisions of XXXXX, MCO, and/or Plan(s) with respect to XXXXX’, MCO’s, and/or Plan(s)’ medical policies and medical management programs, procedures or activities; quality improvement and performance improvement programs, procedures and activities; and utilization and management review; care coordination activities including, but not limited to, medical record reviews, HEDIS reporting, disease management programs, case management, clinical practice guidelines, and other quality measurements to improve Members’ care. PROVIDER further agrees to comply and cooperate with an independent quality review and improvement organization’s activities pertaining to the provision of Covered Services for Medicare, Medicare Advantage, and MA Program Members. Notwithstanding the foregoing, PROVIDER’s obligations to comply with XXXXX’ utilization management program, credential verification program, quality management program and provider sanction program shall not negate PROVIDER’s professional or ethical responsibility or impede PROVIDER from providing information or assistance to Members. Notwithstanding the foregoing, XXXXX on behalf of carrier, may provide data and information to PROVIDER such as: (a) Performance feedback reports or information to the PROVIDER, if compensation is related to efficiency criteria. (b) Information on benefit exclusions; administrative and utilization management requirements; credential verification programs; quality assessment programs; and provider sanction policies. Notification of changes in these requirements shall also be provided by the carrier, allowing PROVIDER time to comply with such changes.

Provider Participation/Cooperation with UR/QM Programs. As applicable, PROVIDER agrees to participate in, cooperate and comply with, and abide by decisions of XXXXX, MCO, and/or Plan(s) with respect to XXXXX’, MCO’s, and/or Plan(s)’ medical policies and medical management programs, procedures or activities; quality improvement and performance improvement programs, procedures and activities; and utilization and management review; care coordination activities including, but not limited to, medical record reviews, HEDIS reporting, disease management programs, case management, clinical practice guidelines, and other quality measurements to improve Members’ care. PROVIDER further agrees to comply and cooperate with an independent quality review and improvement organization’s activities pertaining to the provision of Covered Services for Medicare, Medicare Advantage, and Medical Assistance Program Members. PROVIDER shall implement a continuous quality improvement action plan if areas for improvement are identified. Nothing in this paragraph should be construed as an abrogation of PROVIDER’s right to appeal XXXXX’ decisions as set forth in Exhibit A of this Agreement.

Provider Participation/Cooperation with UR/QM Programs. As applicable, PROVIDER agrees to participate in, cooperate and comply with, and abide by decisions of XXXXX, MCO, and/or Plan(s) with respect to XXXXX’, MCO’s, and/or Plan(s)’ medical policies and medical management programs, procedures or activities; quality improvement and performance improvement programs, procedures and activities; and utilization and management review. PROVIDER further agrees to comply and cooperate with an independent quality review and improvement organization’s activities pertaining to the provision of Covered Services for Medicare, Medicare Advantage, and MA Program Members.

Provider Participation/Cooperation with UR/QM Programs. As applicable, PROVIDER agrees to participate in, cooperate and comply with, and abide by decisions of XXXXX, MCO, and/or Plan(s) with respect to XXXXX’, MCO’s, and/or Plan(s)’ medical policies and medical management programs, procedures or activities; quality improvement and performance improvement programs, procedures and activities; utilization and management review; care coordination activities including, but not limited to, medical record reviews HEDIS reporting, disease management programs, case management, clinical practice guidelines, and other quality measurements to improve Members’ care. PROVIDER further agrees to comply and cooperate with an independent quality review and improvement organization’s activities pertaining to the provision of Provider Services for Medicare, Medicare Advantage, CFC Medicaid and Medicaid Program Members. Further, PROVIDER shall comply with the ODJFS external quality review as described in OAC rule 5101:3-26-07, and shall implement a continuous quality improvement action plan if areas for improvement are identified.