Common use of Quality; Utilization Management Clause in Contracts

Quality; Utilization Management. Provider agrees to participate and cooperate with any quality improvement, utilization review, and management activities established by Subcontractor, Health Plan and/or the Division of TennCare, including actions to improve patient safety and quality. 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 Health Plan or as required under the applicable CRA to ensure that 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.

Quality; Utilization Management. Provider agrees to participate and cooperate with any quality improvement, utilization review, and management activities established by Subcontractor, Health Plan and/or the Division Bureau of TennCare, including actions to improve patient safety and quality. 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 Health Plan or as required under the applicable CRA to ensure that 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.

Quality; Utilization Management. Provider agrees to participate and cooperate with any quality improvement, utilization review, and management activities established by Subcontractor, Health Plan and/or the Division of TennCare, including actions to improve patient safety and quality. 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 Health Plan or as required under the applicable CRA PBM Contract to ensure that 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.