Quality Management Program. Contractor shall maintain a quality management program to review the quality of Covered Services provided by Participating Providers and other subcontractors. Contractor’s quality management program shall be subject to review by Covered California annually to evaluate Contractor’s compliance with requirements set forth in the Quality, Network Management and Delivery System Standards. Contractor shall coordinate and cooperate with Covered California in developing the Quality, Network Management and Delivery System Standards, including (i) participating in meetings and other programs as reasonably requested from time to time by Covered California, (ii) providing mutually agreed upon data and other information required under the Quality, Network Management and Delivery System Standards, and (iii) as otherwise reasonably requested by Covered California. The parties acknowledge and agree that quality related activities contemplated under this Article 4 will be subject to and conducted in compliance with any and all applicable laws, rules and regulations including those relating the confidentiality of medical information and will preserve all privileges set forth at Health and Safety Code § 1370.
Quality Management Program. To adopt and maintain a Quality Management Program consistent with BLUE CROSS standards and approved by BLUE CROSS. This program will cover all Covered Medical Services provided or arranged by PARTICIPATING MEDICAL GROUP for Members. PARTICIPATING MEDICAL GROUP agrees to allow on-site review of its Quality Management Program by BLUE CROSS staff.
Quality Management Program. Contractor shall maintain a quality management program to review the quality of Covered Services provided by Participating Providers and other subcontractors. Contractor’s quality management program shall be subject to review by the Exchange annually to evaluate Contractor’s compliance with requirements set forth in the Quality, Network Management and Delivery System Standards. Contractor shall coordinate and cooperate with the Exchange in developing the Quality, Network Management and Delivery System Standards, including (i) participating in meetings and other programs as reasonably requested from time to time by the Exchange, and (ii) providing mutually agreed upon data and other information required under the Quality, Network Management and Delivery System Standards and (iii) as otherwise reasonably requested by the Exchange. The parties acknowledge and agree that quality related activities contemplated under this Article 4 will be subject to and conducted in compliance with any and all applicable laws, rules and regulations including those relating the confidentiality of medical information and will preserve all privileges set forth at Health and Safety Code § 1370.
Quality Management Program. An ongoing review process and plan which functions to define, monitor, review, and recommend corrective action for managing and improving the quality of health care services to Members.
Quality Management Program. Contractor shall maintain a quality management program to review the quality of Specialized Health Care Services provided by Participating Providers and other subcontractors. Contractor’s quality management program shall be subject to review by the Exchange annually to evaluate Contractor’s compliance with requirements set forth in the Quality, Network Management and Delivery System Standards. Contractor shall coordinate and cooperate with the Exchange in developing the Quality, Network Management and Delivery System Standards, including (i) participating in meetings and other programs as reasonably requested from time to time by the Exchange, and (ii) providing mutually agreed upon data and other information required under the Quality, Network Management and Delivery System Standards and/or (iii) as otherwise reasonably requested by the Exchange. The parties acknowledge and agree that quality related activities contemplated under this Article 4 will be subject to and conducted in compliance with any and all applicable laws, rules and regulations including those relating the confidentiality of medical information and will preserve all privileges set forth at Health and Safety Code 1370. Consistent with The Exchange's mission to promote better care, better health and lower cost as part of a Quality Improvement Strategy, Contractor agrees to:
Quality Management Program. The Contractor shall have an ongoing quality management program for the services it furnishes to members. The quality management program shall include but is not limited to:
Quality Management Program. The functions, including, but not --------------------------- limited to, credentialing and certification of providers, review and audit of medical and other records, outcome rate reviews, peer review and provider appeals and grievance procedures performed or required by Foundation, an Affiliate, a Payor, or any other permitted person or entity, to review and improve the quality of Covered Medical Services rendered to Beneficiaries.
Quality Management Program. 7.1.1 The Contractor shall ensure its Quality Management (QM) program addresses GFS/FBG requirements and meets Crisis Services standards. It shall be the independent obligation of the Contractor to remain current with all GFS/FBG requirements.
Quality Management Program. See Section 4 “Other Contractual Requirements” for more details, requirements, and performance measures The scope of this Contract includes the requirement for a Quality Management Program established by the Contractor as a minimum framework for the Contractor for self-monitoring, self-evaluation, and self-reporting. The Contractor’s Quality Management Program requires a continuous process of self-monitoring and self-evaluation of performance. The expectation is all performance failures will be identified and addressed by the Contractor without Department involvement. When performance failures are identified, the Contractor is expected to correct the failures and review its Operations Plan and Quality Management Plan to determine changes needed to prevent additional performance failures. The Contractor is expected to document all changes and make all documentation available to the Department for review upon request. The Quality Management Program should include a system of checks and balances for the Contractor to validate their operations and provide a consistent and baseline approach to Quality Management practices to ensure compliance with all Contract performance measures. The Quality Management Program should identify the individuals responsible for quality control measures and specific actions that are used to ensure quality results. Quality Management consists of three primary components: Quality Checks, Quality Control Reviews (Back Checks), and Quality Assurance Reviews (Process Reviews).
Quality Management Program. An ongoing review process and plan adopted by HMO which functions to define, monitor, review, and recommend corrective action for managing and improving the quality of Covered Services rendered to Members.
