Quality; Utilization Management. Pursuant to any applicable provider manuals and related protocols, or as elsewhere specified under the Agreement, Provider agrees to cooperate with Subcontractor’s and Health Plan’s quality assessment, performance improvement and utilization review and management activities, which shall be tailored to the nature and type of services subcontracted. This shall include, but not be limited to, participation in any internal and external quality assurance, utilization review, peer review, and grievance procedures established by Subcontractor or Health Plan or as required under the applicable State Contract to ensure quality control for the health care provided, including but not limited to the accessibility of Medically Necessary health care, and Covered Persons have due process for their complaints, grievances, appeals, fair hearings or requests for external review of adverse decisions made by Subcontractor, Health Plan or Provider. Provider shall adhere to the quality assurance and utilization review standards of the State Programs and shall monitor quality and initiate corrective action to improve quality consistent with the generally accepted level of care. Provider is not required to indemnify Subcontractor or Health Plan for any expenses or liabilities incurred in connection with any claim or action brought against Subcontractor or Health Plan based on Subcontractor’s or Health Plan’s management decisions, utilization review provisions or other policies, guidelines or actions except, to the extent, such claim or action is as a result of Provider’s fault or negligence.
Appears in 5 contracts
Samples: Massachusetts Government Programs Regulatory Requirements Appendix, Massachusetts Government Programs Regulatory Requirements Appendix, Massachusetts Government Programs Regulatory Requirements Appendix
