Service and Utilization Management Sample Clauses
The Service and Utilization Management clause defines the procedures and standards for monitoring, reviewing, and managing the use of services provided under an agreement. Typically, this clause outlines how the provider will assess the necessity, appropriateness, and efficiency of services rendered, often through pre-authorization requirements, concurrent reviews, or retrospective audits. Its core function is to control costs and ensure that services delivered are medically necessary and consistent with established guidelines, thereby preventing overuse or misuse of resources.
Service and Utilization Management. The CMHSP shall assure that customers located in the service area have clear and identifiable access to needed supports and services when they are needed, and that supports and services are of high quality and delivered according to established regulations, standards, and best practice guidelines. The CMHSP shall also perform utilization management functions sufficient to control costs and minimize risk while assuring quality care and in compliance with Section 208 of the Mental Health Code. Additional requirements are described in the following sub-sections.
Service and Utilization Management. The PIHP shall assure that customers located in the service area have clear and identifiable access to needed supports and services when they are needed, and that supports and services are of high quality and delivered according to established regulations, standards, and practice guidelines. The PIHP shall also perform utilization management functions sufficient to control costs and minimize risk while assuring quality care. Additional requirements are described in the following subsections.