Quality Assurance/Utilization Review. Physician shall actively participate in, and cooperate with Corporation in connection with the development and implementation of a quality assurance and risk management program for Corporation. Physician shall also be subject to and actively participate in any utilization review program developed by or on behalf of Corporation in respect of Corporation.
Quality Assurance/Utilization Review. A. Contractor agrees to be in compliance with the Laws and Regulations Article of this Contract.
B. County shall establish standards and implement processes for Contractor that will support understanding of, compliance with, documentation standards set forth by the State. The County has the right to monitor performance so that the documentation of care provided will satisfy the requirements set forth. The documentation standards for beneficiary care are minimum standards to support claims for the delivery of specialty mental health services. All documentation shall be addressed in the beneficiary record.
C. Contractor agrees to implement a Quality Improvement Program as part of program operations. This program will be responsible for monitoring documentation, quality improvement and quality care issues. Contractor will work with DBH Quality Management Division on a regular basis, and provide any tools/documents used to evaluate Contractor’s documentation, quality of care and the quality improvement process.
D. When quality of care documentation or issues are found to exist by DBH, Contractor shall submit a plan of correction to be approved by DBH Quality Management.
E. Contractor agrees to be part of the County Quality Improvement planning process through the annual submission of Quality Improvement Outcomes in County identified areas.
Quality Assurance/Utilization Review. I. Contractor agrees for the County to have a monitoring system in effect to evaluate the performance of the Contractor.
II. Contractor agrees to be in compliance with the Laws and Regulations Article of this Contract.
III. Contractor agrees to implement a Quality Improvement Program as part of program operations. This program will be responsible for monitoring documentation, quality improvement and quality care issues. Contractor will submit its quality improvement plan to DBH SUDRS Administration on an annual basis, and any tools/documents used to evaluate Contractor’s documentation, quality of care and the quality improvement process.
IV. When quality of care documentation or issues are found to exist by DBH, Contractor shall submit a plan of correction to be approved by DBH SUDRS Administration.
V. Contractor agrees to be part of the County Quality Improvement planning process through the annual submission of Quality Improvement Outcomes in County identified areas.
VI. County shall establish standards and implement processes for Contractor that will support understanding of, compliance with, documentation standards set forth by the State. The County has the right to monitor performance so that the documentation of care provided will satisfy the requirements set forth. The documentation standards for beneficiary care are minimum standards to support claims for the delivery of behavioral health services. All documentation shall be addressed in the beneficiary record.
Quality Assurance/Utilization Review. Physician Group shall establish mechanisms acceptable to Health Plan, the Department of Corporations and HCFA whereby they will review on a prospective, concurrent and retrospective basis the quality, appropriateness and level of care and utilization of services provided to Enrollees.
Quality Assurance/Utilization Review. Provider Qualifications. RSAI shall assist ASA in the establishment and implementation of procedures to ensure the consistency and quality of Services provided by ASA, and shall provide daily onsite support for ASA’s quality-assurance and utilization-review and other programs that may be required under ASA’s contracts with hospitals. RSAI agrees to ensure that each surgical assistant providing services through ASA shall have and maintain certain specified qualifications and certifications, and provide evidence of same. RSAI’s failure to adhere to this standard will be grounds for termination of this Agreement.
