Retrospective Hospital Reviews Sample Clauses

Retrospective Hospital Reviews. The Contractor shall have the capability and established procedures to receive Retrospective review request for Inpatient and Outpatient services within sixty (60) days of the service date and conduct prepayment reviews. The Contractor shall ensure determinations for Retrospective Reviews are completed ninety-eight percent (98%) of the time within twenty (20) business days of receipt. The Contractor shall develop and maintain a Web-based, electronic review request system for Prior Authorization and prepayment review of inpatient medical/surgical services that allows for data input by the submitting providers. The Contractor’s system shall have the capability for automated criteria/rules-based certification system. The Contractor shall manually review each Prior Authorization and prepayment review request received that is not certified by the Contractor’s rules- based system, along with any required supporting documentation to support the need for inpatient medical/surgical services. a. The Contractor shall have the capability and established procedures for verbal consultation by the physician reviewer with the attending physician to obtain additional information when the documentation submitted does not clearly support medical necessity. b. The Contractor shall ensure that all cases (including reductions) not meeting medical necessity criteria for inpatient medical/surgical services are reviewed by medical directors duly licensed in Mississippi and in compliance with Miss. Code Xxx. § 41-83-31. At any point after an initial denial a physician who has had a denial may request a review by a reviewer of the same specialty for the case in question. The Contractor shall have the capability and established procedures for verbal and written notification to the requesting provider of a pended review and for informing the provider of the information needed along with a time frame for submission. The Contractor shall have the capability and established procedures for verbal and written notification to the requesting provider of a suspended review. Notification to providers of suspended reviews shall not exceed the following: Emergency Admission Reviews Verbal Notification to Provider Within four (4) hours past due date for requested information Non-Emergency Admission Reviews Written Notification to Provider Within one (1) business day past due date for requested information Weekend and Holiday Admission Reviews Continued Stay Reviews Retrospective Inpatient Hospita...
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Related to Retrospective Hospital Reviews

  • Log Reviews All systems processing and/or storing PHI COUNTY discloses to 11 CONTRACTOR or CONTRACTOR creates, receives, maintains, or transmits on behalf of COUNTY 12 must have a routine procedure in place to review system logs for unauthorized access.

  • Health Plan An appropriately licensed entity that has entered into a contract with Subcontractor, either directly or indirectly, under which Subcontractor provides certain administrative services for Health Plan pursuant to the State Contract. For purposes of this Appendix, Health Plan refers to UnitedHealthcare Insurance Company.

  • Periodic Reviews During January of each year during the term hereof, the Board of Directors of the Company shall review Executive's Annual Salary, bonus, stock options, and additional benefits then being provided to Executive. Following each such review, the Company may in its discretion increase the Annual Salary, bonus, stock options, and benefits; however, the Company shall not decrease such items during the period Executive serves as an employee of the Company. Prior to November 30th of each year during the term hereof, the Board of Directors of the Company shall communicate in writing the results of such review to Executive.

  • Pilot Programs The Employer may develop voluntary pilot programs to test the acceptability of various risk management programs. Incentives for participation in such programs may include limited short-term improvements to the benefits outlined in this Article. Implementation of such pilot programs is subject to the review and approval of the Joint Labor-Management Committee on Health Plans.

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

  • Annual Reviews Within thirty (30) days after each annual anniversary of the Effective Date of this Agreement, the Company shall review Employee’s performance of his duties pursuant to this Agreement and advise Employee of the results of that review; provided, however, that Company may elect to conduct a partial-year performance review in order to synchronize Employee’s annual review date with that of the Company’s other executives. In connection with each such review, the Company shall evaluate whether any increase in Employee’s compensation under Section 2, below, is appropriate.

  • Extended Health Plan An employee who makes an election under this provision must enrol in each and every of the benefit plans and shall not be entitled to except any of them.

  • JOINT LABOR MANAGEMENT COMMITTEE The parties agree that they will continue the Joint Labor-Management Committee to discuss matters of mutual interest relating to the employees covered by this Agreement. Topics for the Joint Labor-Management Committee may include, but are not limited to, Professional Development, Incentive Pay, etc. The Committee shall meet quarterly or as mutually agreed by the co-chairs. The President of CWA or designee and the Director of Human Resources or designee shall serve as co-chairs.

  • SALARY SACRIFICE ARRANGEMENTS 34.1 Employees covered by this Agreement will have access to salary sacrifice arrangements in addition to the compulsory arrangement detailed above. The requirements of any such arrangements shall ensure that: (a) Accessing a salary sacrifice arrangement is a voluntary decision to be made by the individual Employee. (b) An Employee wishing to enter into a salary sacrifice arrangement will be required to notify their Employer in writing of the intention to do so and have sought expert advice in relation to entering into such an arrangement. (c) The Employer shall meet the cost of implementing the administrative and payroll arrangements necessary for the introduction of salary sacrifice to the Employees under the Agreement. (d) The co-contribution of superannuation payments referred to herein shall be made by way of salary sacrifice arrangements.

  • EMPLOYEE EVALUATIONS 6.1 Administrators will meet with new employees to discuss their job description within one (1) month of hire. The Administrator and new employee will sign off on the job description and it will be forwarded to the Human Resources Department for inclusion in the employee‘s personnel file. The Human Resources Department will compile and distribute a list showing each employee‘s evaluator prior to November 1st of each year. Bargaining unit job descriptions will be made available via the District‘s web site. 6.2 Evaluations will transpire as follows for employees that are receiving satisfactory ratings: a. New hires—regular part-time (school year employees) will be evaluated at three (3) and six (6) working months. b. New hires—full time (12 month employees) will be evaluated at three (3), six (6) and twelve (12) months. c. After the initial year of employment, each employee shall be evaluated at least once annually by March 31st. 6.3 Criteria for evaluating bargaining unit members will be based on the performance categories outlined on the evaluation form as related to the job description of their specific position assignment. 6.4 Evaluation reports shall include feedback regarding strengths and weaknesses (if any) demonstrated by the employee. Prior to an employee receiving a rating less than “Meets Expectations,” the employee shall be advised of the performance concern and provided with a clear statement of any deficiency and a statement defining acceptable performance. This shall occur within a reasonable time prior to the final evaluation to allow the employee a chance to demonstrate improvement. 6.5 In the event an employee is evaluated overall as “Does Not Meet Expectations,” the district, in consultation with the employee and the Association, will provide the employee a written plan of improvement (See Employee Plan of Improvement form in Appendix). The plan shall clearly define all areas of deficiency, provide clear and attainable performance goals, and outline supports (if any) to be given, including any necessary training at the District’s expense. The employee will be given a reasonable amount of time, not to exceed sixty (60) working days, to meet job performance expectations. During the improvement period, feedback will be provided through a minimum of three scheduled meetings. Following the completion of the plan, the supervisor shall notify the employee in writing of the outcome. Failure to demonstrate satisfactory improvement may constitute grounds for termination. 6.6 The bargaining unit member shall be given a copy of their evaluation, and any data collection sheets (with the submitters name excluded) used in the evaluation. 6.7 Under the law there is no right to Association Representation at evaluation conferences. 6.8 Any information shared with the evaluating administrator for the evaluation process shall be recorded on Data Collection Sheet(s), with the exception of those unit members that have supervising teachers. Supervising teachers will work directly with the evaluating administrator to share performance information for inclusion in the unit member‘s evaluation. 6.9 Employees shall have the right to respond to evaluations in writing. Such written response shall be attached to the evaluation if received within 5 days. 6.10 No bargaining unit member shall be required to sign a blank or incomplete evaluation form.

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