Common use of Termination of Delegation Clause in Contracts

Termination of Delegation. FHS shall have the right to audit PPG’s performance of utilization management, quality improvement, credentialing and recredentialing, Member grievance and appeal, medical record review, and capitation and claims adjudication functions from time to time. If FHS determines that deficiencies exist in PPG’s performance, PPG shall accept consulting assistance from FHS. Failure to cure any identified deficiencies within a reasonable period of time as defined by FHS policies, or if FHS determines PPG does not have the ability to perform delegated functions, or is not effectively performing delegated functions, FHS may revoke delegation of all or any of these functions in accordance with procedures set forth in the Operations Manual and re-assume the performance of such functions itself. Should it become necessary for FHS to reassume delegated functions, FHS shall charge the following administrative fees: utilization management *** of PPG Capitation; quality improvement *** of PPG Capitation; claims processing *** of PPG Capitation.

Termination of Delegation. FHS HNI shall have the right to audit PPG’s performance of utilization management, quality improvement, credentialing and recredentialing, Member grievance and appeal, medical record review, and capitation and claims adjudication functions from time to time. If FHS HNI determines that deficiencies exist in PPG’s performance, PPG shall accept consulting assistance from FHSHNI. Failure to cure any identified deficiencies within a reasonable period of time as defined by FHS HNI policies, or if FHS HNI determines PPG does not have the ability to perform delegated functions, or is not effectively performing delegated functions, FHS HNI may revoke delegation of all or any of these functions in accordance with procedures set forth in the Operations Manual and re-assume the performance of such functions itself. Should it become necessary for FHS HNI to reassume delegated functions, FHS HNI shall charge the following administrative fees: utilization management *** 2.5% of PPG Capitation; quality improvement *** credentialing 2.5% of PPG Capitation; and claims processing *** 2.5% of PPG Capitation.

Termination of Delegation. FHS shall have the right to audit PPG’s performance of utilization management, quality improvement, credentialing and recredentialing, . Member grievance and appeal, medical record review, and capitation and claims adjudication functions from time to time. If FHS determines that deficiencies exist in PPG’s performance, PPG shall accept consulting assistance from FHS. Failure to cure any identified deficiencies within a reasonable period of time as defined by FHS policies, or if FHS determines PPG does not have the ability to perform delegated functions, or is not effectively performing delegated functions, FHS may revoke delegation of all or any of these functions in accordance with procedures set forth in the Operations Manual and re-assume the performance of such functions itself. Should it become necessary for FHS to reassume delegated functions, FHS shall charge the following administrative fees: utilization management *** 4% of PPG Capitation; quality improvement *** 3% of PPG Capitation; claims processing *** 3.5% of PPG Capitation.

Termination of Delegation. FHS shall have the right to audit PPG’s performance of utilization management, quality improvement, credentialing and recredentialing, Member grievance and appeal, medical record review, and capitation and claims adjudication functions from time to time. If FHS determines that deficiencies exist in PPG’s performance, PPG shall accept consulting assistance from FHS. Failure to cure any identified deficiencies within a reasonable period of time as defined by FHS policies, or if FHS determines PPG does not have the ability to perform delegated functions, or is not effectively performing delegated functions, FHS may revoke delegation of all or any of these functions in accordance with procedures set forth in the Operations Manual and re-assume the performance of such functions itself. Should it become necessary for FHS to reassume delegated functions, FHS shall charge the following administrative fees: fees utilization management *** 4% of PPG Capitation; quality improvement *** 3% of PPG Capitation; claims processing *** 3.5% of PPG Capitation.