Common use of UM Program Clause in Contracts

UM Program. County shall comply with CalOptima’s UM Program including: 3.3.1 County acknowledges and agrees that CalOptima has implemented and maintains a UM Program that addresses evaluations of Medical Necessity and processes to review and approve the provision of items and services, including LHA Services, to Members. County shall comply with the requirements of the UM Program including, without limitation, those criteria applicable to the LHA Services as described in this Contract. 3.3.2 County shall comply with all Prior Authorization, concurrent and retrospective review and authorization requirements as set forth in CalOptima Policies. Prior authorization is not required for initial referrals to Physicians practicing a medical specialty as defined by the American Board of Medical Specialties, Emergency Services, and Family Planning Services or for access to Sensitive Services and basic prenatal care. 3.3.3 County Associates may not admit a Member to a hospital on a non-emergency basis without first receiving prior authorization from CalOptima’s UM Department. 3.3.4 County Associates shall permit CalOptima’s UM Department staff and other qualified representatives of CalOptima to conduct on site reviews of the medical records of Members. CalOptima staff shall notify County prior to conducting such on site reviews and shall wear appropriate identification.

UM Program. County shall comply with CalOptima’s 's UM Program including: 3.3.1 County acknowledges and agrees that CalOptima has implemented and maintains a UM Program that addresses evaluations of Medical Necessity and processes to review and approve the provision of items and services, including LHA Services, to Members. County shall comply with the requirements of the UM Program including, without limitation, those criteria applicable to the LHA Services as described in this Contract. 3.3.2 County shall comply with all Prior Authorization, concurrent and retrospective review and authorization requirements as set forth in CalOptima Policies. Prior authorization is not required for initial referrals to Physicians practicing a medical specialty as defined by the American Board of Medical Specialties, Emergency Services, and Family Planning Services or for access to Sensitive Services and basic prenatal care. 3.3.3 County Associates may not admit a Member to a hospital on a non-emergency basis without first receiving prior authorization from CalOptima’s 's UM Department. 3.3.4 County Associates shall permit CalOptima’s 's UM Department staff and other qualified representatives of CalOptima to conduct on site reviews of the medical records of Members. CalOptima staff shall notify County prior to conducting such on site reviews and shall wear appropriate identification.

UM Program. County shall comply with CalOptima’s UM Program including: 3.3.1 County acknowledges and agrees that CalOptima has implemented and maintains a UM Program that addresses evaluations of Medical Necessity and processes to review and approve the provision of items and services, including LHA Services, Services at Be Well OC Wellness Hub to Members. County shall comply with the requirements of the UM Program including, without limitation, those criteria applicable to the LHA Services at Be Well OC Wellness Hub as described in this Contract. 3.3.2 County shall comply with all Prior Authorization, concurrent and retrospective review and authorization requirements as set forth in CalOptima Policies. Prior authorization is not required for initial referrals to Physicians practicing a medical specialty as defined by the American Board of Medical Specialties, Emergency Services, and Family Planning Services or for access to Sensitive Services and basic prenatal care. 3.3.3 County Associates may not admit a Member to a hospital on a non-emergency basis without first receiving prior authorization from CalOptima’s UM Department. 3.3.4 County Associates shall permit CalOptima’s UM Department staff and other qualified representatives of CalOptima to conduct on site reviews of the medical records of Members. CalOptima staff shall notify County prior to conducting such on site reviews and shall wear appropriate identification.