Quality Assurance Programs. Provider agrees to participate in any and all quality improvement and utilization management programs implemented by Blue Shield as more fully described in the Provider Manual. Moreover, Provider agrees to participate in Blue Shield’s provider credentialing and recredentialing programs. If Provider concludes that care recommended or authorized through the utilization management program is medically inappropriate for the Member, Provider may access the expedited appeal process as described in the Provider Manual. Provider may also furnish that care which Provider, in the exercise of good medical judgment, believes is medically appropriate and may appeal any coverage denial by Blue Shield in accordance with the provisions of Article VIII hereof.
Quality Assurance Programs. Contractor has sole responsibility for the quality assurance and quality control of the Work, including all work of its Subcontractors. Contractor shall use effective quality assurance programs throughout the performance of the Work that are substantially similar to those set forth in Exhibit L. Within sixty (60) days after the Effective Date, Contractor shall provide for Owner’s review Site-specific quality assurance program documentation and shall incorporate all reasonable edits from Owner.
Quality Assurance Programs. The goal of our Quality Program is to ensure the provision of consistently excellent health care, health information and service to you, enabling you to maintain and improve your physical and behavioral health and well-being. Some components of the quality program are directed to all Covered Persons and others address specific medical issues and providers. Examples of quality activities in place for all Covered Person’s include a systematic review and re-review of the credentials of Network providers and contracted facilities, as well as the development and dissemination of clinical standards and guidelines in areas such as preventive care, medical records, appointment access, confidentiality, and the appropriate use of drug therapies and new medical technologies. Activities affecting specific medical issues and providers include disease management programs for those with chronic diseases like asthma, diabetes and congestive heart failure, and the investigation and resolution of quality-of-care complaints registered by individual Covered Persons. Your coverage in this health plan is not limited based on medical conditions that are present on or before your effective date. This means that your health care services will be covered from the effective date of your coverage in this health plan without a pre-existing condition restriction or a waiting period. But, benefits for these health care services are subject to all provisions of this health plan.
Quality Assurance Programs. The State shall develop and implement quality assurance programs for protection from harm, suicide prevention, mental health care, medical care, special education services and fire safety.
Quality Assurance Programs. Provider agrees to participate in any and all quality improvement and utilization management programs implemented by Health Plan as more fully described in the Provider Manual. Moreover, Provider agrees to participate in Health Plan’s provider credentialing and recredentialing programs. If Provider concludes that care recommended or authorized through the utilization management program is medically inappropriate for the Member, Provider may access the expedited appeal process as described in the Provider Manual. Provider may also furnish that care which Provider, in the exercise of good medical judgment, believes is medically appropriate and may appeal any coverage denial by Health Plan in accordance with the provisions of Article VIII hereof.
Quality Assurance Programs. The State shall create or modify and implement quality assurance programs consistent with generally accepted professional standards for each of the substantive remedial areas addressed in this Agreement. In addition, the State shall:
a. create or modify and implement policies and procedures to address problems that are uncovered during the course of quality assurance activities; and
b. create or modify and implement corrective action plans to address identified problems in such a manner as to prevent them from occurring again in the future.
Quality Assurance Programs. Use effective quality assurance programs, reasonably acceptable to Owner and consistent with the requirements of Exhibit A and Exhibit S in performing the Work. Within sixty (60) days after the Notice to Proceed Date, Contractor shall provide a Notice to Owner describing such quality assurance programs to be used by Contractor in the performance of the Work. Owner shall have the right to review and comment on such programs as described in Contractor’s Notice hereunder; provided, however, that Contractor shall remain solely responsible for performing the Work in accordance with this Contract. If Owner provides any comments with respect to such quality assurance programs to Contractor, then Contractor shall promptly incorporate changes into such quality assurance programs or otherwise address such comments, and resubmit the same to Owner. Such incorporation of changes to address Owner’s comments shall not be considered a Change in Work unless the changes are not reasonable, are not required by Industry Standards or Applicable Laws, and materially affect Contractor’s cost or schedule. If Owner fails to comment within twenty (20) Business Days after receipt of such Notice, Owner shall be deemed to have accepted such programs.
Quality Assurance Programs. Use effective quality assurance programs, acceptable to Owner and consistent with the requirements of Exhibit A-1–Section 01440 in performing the Work. During the Open Book Review, Contractor shall prepare a quality assurance/quality control program and provide a Notice to Owner, for Owner’s approval, describing such quality assurance programs to be used by Contractor in the performance of the Work. Contractor shall comply with the approved quality assurance program throughout the performance of the Work.
Quality Assurance Programs. The State shall develop and implement Quality Assurance programs consistent with generally accepted professional practices for each discipline addressed in this MOA.
Quality Assurance Programs. Use effective quality assurance programs, acceptable to Owner and consistent with Part I, Reference 4-1 of the Scope Book in performing the Work. Within thirty (30) days after the Full Notice to Proceed Date, Contractor shall provide a Notice to Owner, for Owner’s approval, describing such quality assurance programs to be used by Contractor in the performance of the Work. Owner shall review, comment on, and approve or disapprove such program in writing within thirty (30) days after submission by Contractor. If Owner conditions its approval on reasonable changes in the quality assurance program submitted by Contractor, Contractor shall effect such changes at no additional cost to Owner and resubmit such program to Owner within ten (10) days after Contractor receives Owner’s conditional approval. Owner will have ten (10) days after such resubmission to review, comment on, and approve or disapprove such programs resubmitted by Contractor. Such procedure shall continue with the same ten (10) day time periods until such programs are approved by Owner; provided, however, that if the Parties cannot reach agreement after the third submittal by Contractor, the Parties’ differences shall be resolved in accordance with the procedures provided in Article 32. If Owner fails to respond within any of the applicable periods specified above, Owner shall be deemed to have approved the last such programs submitted by Contractor. Contractor shall comply with the approved quality assurance program throughout the performance of the Work. Contractor shall cause each Major Subcontractor to implement a Contractor-approved quality assurance program and comply with same throughout its performance of the Work.
