Common use of Specific Capabilities Clause in Contracts

Specific Capabilities. The system should: 1. Include a database for utilization, referrals, tracking function for utilization controls, and consultant services. 2. Accommodate and apply standard norms/criteria and medical, behavioral, dental and MLTSS policy standards for quality of care and utilization review. 3. Include all types of claims and encounters data along with service authorizations and referrals. 4. Include pharmacy utilization data from MH/SUD providers. 5. Interface, as applicable, with external utilization and quality assurance/measurement software programs. 6. Include tracking of coordination requirements with MH/SUD providers and the State’s designated Interim Managing Entity (IME) for SUD services. 7. Include ability to protect patient confidentiality through the use of masked identifiers and other safeguards as necessary.

Specific Capabilities. The system should: 1. Include a database for utilization, referrals, tracking function for utilization controls, and consultant services. 2. Accommodate and apply standard norms/criteria and medical, behavioral, dental and MLTSS policy standards for quality of care and utilization review. 3. Include all types of claims and encounters data along with service authorizations and referrals. 4. Include pharmacy utilization data from MH/SUD SA providers. 5. Interface, as applicable, with external utilization and quality assurance/measurement software programs. 6. Include tracking of coordination requirements with MH/SUD SA providers and the State’s designated Interim Managing Entity (IME) for SUD SA services. 7. Include ability to protect patient confidentiality through the use of masked identifiers and other safeguards as necessary.

Specific Capabilities. The system should: 1. Include a database for utilization, referrals, tracking function for utilization controls, and consultant services. 2. Accommodate and apply standard norms/criteria and medical, behavioral, dental and MLTSS policy standards for quality of care and utilization review. 3. Include all types of claims and encounters data along with service authorizations and referrals. 4. Include pharmacy utilization data from MH/SUD SA providers. 5. Interface, as applicable, with external utilization and quality assurance/measurement software programs. 6. Include tracking of coordination requirements with MH/SUD providers and the State’s designated Interim Managing Entity (IME) for SUD servicesSA providers. 7. Include ability to protect patient confidentiality through the use of masked identifiers and other safeguards as necessary.