SPECIFIC SERVICES FOR RISK CONTRACTS Sample Clauses

SPECIFIC SERVICES FOR RISK CONTRACTS. As more particularly described in Exhibit A, NAMM will provide the following services to the company with respect to Risk Contracts Performance of these services will be in compliance with parameters outlined in the HMO agreements between any HMO and the PHO. The parties agree that certain services are "core" services which will in all cases be provided by NAMM (including those set forth in paragraphs (i), (ii), (iii), (iv), (v), (vi), (vii), (viii), and (ix) below). NAMM will also look to existing affiliated Physician Organization and PHO standards when providing any of the services listed below and will try, to the extent reasonably possible, to coordinate standards it implements or recommends with such PHO standards. In addition, any such significant changes and/or additional standards will be communicated to the PHO and Company prior to being implemented by NAMM. (i) Prepare and adopt initial benchmark utilization review and quality management procedures. (ii) Perform claims processing for providers. (iii) Perform provider contracting services. (iv) Perform utilization management and quality assurance services, which will include utilization authorization, concurrent review, case management, and discharge planning, and establish credentialing criteria and grievance procedures. (v) Perform member services relating to claims matters. (vi) Establish and maintain financial management for the PHO including risk-sharing administration only with respect to the Risk contracts and program. (vii) Administer provider education programs as reasonably necessary. (viii) Prepare semi-annual individual and aggregate physician profiling reports comparing physician performances to adopted utilization review standards. (ix) Recommend and administer quality outcome standards and accompanying reports comparing physician performance to standards required by the applicable HMOs.