Quality and Utilization Management. The Practice acknowledges and agrees that a quality and utilization management program for determining the medical necessity and appropriateness of care rendered by the Practice provides controls and protections that assist to prevent potential overutilization with any fee-for-service arrangement including, but not limited to, those reimbursable under federal health insurance programs and also provides essential data to the Practice and the Company for the purposes of managing the Cancer Centers and negotiating, administering and maintaining Third-Party Payor contracts. The Practice and the Company agree to develop and implement a quality and utilization management program in accordance with recommendations made by the Company, the Practice, or the Medical Advisory Board or as required under Third-Party Payor contracts. The Practice shall cause the Physicians to participate in the development of such programs and to comply with the standards, protocols or practice guidelines established thereby, and the Practice will ensure that such individuals are required by their employment agreements or other contracts to do so. The Company is authorized by the Practice to prepare and distribute reports of such program activities to employees of, and consultants to the Practice and the Company, to Third-Party Payors, and to such other Persons as the Company deems necessary in order for the Company to carry out its obligations hereunder.
Quality and Utilization Management. PA ACKNOWLEDGES AND AGREES THAT A QUALITY AND UTILIZATION MANAGEMENT PROGRAM FOR DETERMINING THE MEDICAL NECESSITY AND APPROPRIATENESS OF CARE RENDERED BY PA PROVIDES CONTROLS AND PROTECTIONS THAT ASSIST TO PREVENT POTENTIAL OVERUTILIZATION WITH ANY FEE FOR SERVICE ARRANGEMENT, INCLUDING, BUT NOT LIMITED, TO THOSE REIMBURSABLE UNDER FEDERAL HEALTH INSURANCE PROGRAMS AND ALSO PROVIDES ESSENTIAL DATA TO PA AND MANAGER FOR THE PURPOSES OF MANAGING THE PRACTICE AND NEGOTIATING, ADMINISTERING AND MAINTAINING PAYOR CONTRACTS. PA and Manager agree to develop and implement a quality and utilization management program in accordance with recommendations made by Manager and PA, or as required under Payor Contracts. PA shall cause Physicians and employed, supervised or affiliated Allied Health Professionals to participate in the development of such programs and to comply with the standards, protocols or practice guidelines established thereby and PA will ensure that such individuals are required by their Physician Employment Agreements or other contracts to do so. Manager is authorized by PA to prepare and distribute reports of such PA program activities to employees of, and consultants to, PA and Manager, to Payors, and to such other persons as manager deems necessary in order for Manager to carry out its obligations hereunder.
Quality and Utilization Management. Provider agrees to participate in quality improvement activities, care coordination activities, grievance procedures, continuing medical education requirements and other policies and programs of the CMO as may be required from time to time. Provider shall cooperate with the CMO in satisfying the accreditation standards of NCQA and OMPP, among others. Provider agrees to participate in and cooperate with the decision, rules and regulations established by the CMO’s medical management and disease management programs. Provider also agrees to abide by the terms of the CMO's Care Select quality improvement incentive plan, if applicable.
Quality and Utilization Management. Participating Provider shall cooperate with Avesis and Sponsor’s Quality Management and Utilization Management Program requirements. Participating Provider recognizes that Avesis shall monitor Participating Provider’s performance on an ongoing basis and subject Participating Provider to formal review according to a period schedule established by DPW, consistent with industry standards and State laws and regulations including those of the American Academy of Pediatric Dentistry. In the event that Avesis identifies deficiencies or areas needing improvement, Avesis shall develop a corrective action plan and Participating Provider shall implement said plan.
Quality and Utilization Management. (a) Dental Specialty Provider shall participate in the Dental HMO Network Quality Assurance Program ("Program") developed by HMSA. Dental Specialty Provider may be asked to participate on one or more of the committees established by the Program. The Program shall include but is not limited to committees which address:
Quality and Utilization Management. ProMedCo will assist ADC in fulfilling its obligation to its patients to maintain high quality and efficient medical and professional services, including patient satisfaction programs, employee education, outcomes analysis, utilization programs, clinical protocol development and to implement a risk management program.
Quality and Utilization Management. H. Continuity of Care in Enrollment
Quality and Utilization Management. THE PRACTICE OPERATOR ACKNOWLEDGES AND AGREES THAT A QUALITY AND UTILIZATION MANAGEMENT PROGRAM FOR DETERMINING THE MEDICAL NECESSITY AND APPROPRIATENESS OF CARE RENDERED BY THE PRACTICE OPERATOR PROVIDES CONTROLS AND PROTECTIONS THAT ASSIST TO PREVENT POTENTIAL OVERUTILIZATION WITH ANY FEE FOR SERVICE ARRANGEMENT, INCLUDING, BUT NOT LIMITED, TO THOSE REIMBURSABLE UNDER FEDERAL HEALTH INSURANCE PROGRAMS AND ALSO PROVIDES ESSENTIAL DATA FOR THE PURPOSES OF MANAGING THE PRACTICE AND NEGOTIATING, ADMINISTERING AND MAINTAINING PAYOR CONTRACTS. The Practice Operator agrees to develop and implement a quality and utilization management program as provided herein, or as required under Payor Contracts. The Practice Operator shall cause Physicians and employed, supervised or affiliated Allied Health Professionals to participate in the development of such programs and to comply with the standards, protocols or practice guidelines established thereby and the Practice Operator will ensure that such individuals are required by their Physician Employment Agreements or other contracts to do so.
Quality and Utilization Management. THE PRACTICE OPERATOR ACKNOWLEDGES AND AGREES THAT A QUALITY AND UTILIZATION MANAGEMENT PROGRAM FOR DETERMINING THE MEDICAL NECESSITY AND APPROPRIATENESS OF CARE RENDERED BY THE PRACTICE OPERATOR PROVIDES CONTROLS AND PROTECTIONS THAT ASSIST TO PREVENT POTENTIAL OVERUTILIZATION WITH ANY FEE FOR SERVICE ARRANGEMENT, INCLUDING, BUT NOT LIMITED, TO THOSE REIMBURSABLE UNDER FEDERAL HEALTH INSURANCE PROGRAMS AND ALSO PROVIDES ESSENTIAL DATA TO THE PRACTICE OPERATOR AND MANAGER FOR THE PURPOSES OF MANAGING THE PRACTICE AND NEGOTIATING, ADMINISTERING AND MAINTAINING PAYOR CONTRACTS. The Practice Operator and Manager agree to develop and implement a quality and utilization management program in accordance with recommendations made by Manager and the Practice Operator, or as required under Payor Contracts. The Practice Operator shall cause Physicians and employed, supervised or affiliated Allied Health Professionals to participate in the development of such programs and to comply with the standards, protocols or practice guidelines established thereby and the Practice Operator will ensure that such individuals are required by their Physician Employment Agreements or other contracts to do so. Manager is authorized by the Practice Operator to prepare and distribute reports of such Practice program activities to employees of, and consultants to, the Practice Operator and Manager, to Payors, and to such other persons as Manager deems necessary in order for Manager to carry out its obligations hereunder.
Quality and Utilization Management. Administrator shall provide such administrative support for Group’s quality and utilization management committee(s) and activities as reasonably requested by Group from time to time.
