Use of Board. The Union is hereby granted permission to use the bulletin board at the County Sheriff's Department office.
Use of Board owned Vehicles
Use of Board. Certified Consultants
1. The IPA has written procedures for using board-certified consultants to assist in making medical necessity determinations. 2. The IPA provides evidence that it uses board- certified consultants for medical necessity determinations. CRITICAL FACTOR. Monthly UM Logs Annual audit of IPA policies and procedures, workplan, program, committee meetings and Ownership and Control documentation. Monthly log and focused denial and approval file selection review. See Corrective Action Plan (CAP) Requirements in MC_25A4. Revised Date: 01/01/2023 Page 19 of 80 ATTACHMENT III: DELINEATION OF UTILIZATION MANAGEMENT Delegated Activity IEHP Responsibilities Delegate Responsibilities Frequency of Reporting Process for Evaluating Delegates Performance Corrective Actions if Delegate Fails to Meet Responsibilities * MUST PASS Element Revised Date: 01/01/2023 Page 20 of 80
2. The IPA does not specifically reward practitioners or other individuals for issuing denials of coverage or care. 3. Financial incentives for UM decision makers do not encourage decisions that result in underutilization. Monthly UM Logs Annual audit of IPA policies and procedures, workplan, program, committee meetings and Ownership and Control documentation. Monthly log and focused denial and approval file selection review. See Corrective Action Plan (CAP) Requirements in MC_25 A4.
Use of Board. Certified Consultants
1. The IPA has written procedures for using board-certified consultants to assist in making medical necessity determinations. 2. The IPA provides evidence that it uses board-certified consultants for medical necessity determinations. CRITICAL FACTOR. E The IPA distributes a statement to all members and to all practitioners, providers and employees who make UM decisions, affirming the following: Monthly UM Logs Monthly UM Logs Annual audit of IPA Policies and Procedures, Workplan, Program, Committee Meetings and Ownership and Control documentation. Monthly log and focused denial and approval file selection review. See Corrective Action Plan (CAP) Requirements in MA_25A3. Delegated Activity IEHP Responsibilities Delegate Responsibilities Frequency of Reporting Process for Evaluating Delegates Performance Corrective Actions if Delegate Fails to Meet Responsibilities
2. The IPA does not specifically reward practitioners or other individuals for issuing denials of coverage. 3. Financial incentives for UM decision makers do not encourage decisions that result in underutilization. Annual audit of IPA Policies and Procedures, Workplan, Program, Committee Meetings and Ownership and Control documentation. Monthly log and focused denial and approval file selection review. See Corrective Action Plan (CAP) Requirements in MA_25A3 Delegated Activity IEHP Responsibilities Delegate Responsibilities Frequency of Reporting Process for Evaluating Delegates Performance Corrective Actions if Delegate Fails to Meet Responsibilities
Use of Board. Certified Consultants
1. The IPA has written procedures for using board-certified consultants to assist in making medical necessity determinations. 2. The IPA provides evidence that it uses board-certified consultants for medical necessity determinations. CRITICAL FACTOR. Monthly UM Logs Annual audit of IPA policies and procedures, workplan, program, committee meetings and Ownership and Control documentation. Monthly log and focused denial and approval file selection review. See Corrective Action Plan (CAP) Requirements in MC_25A4.
2. The IPA does not specifically reward practitioners or other individuals for issuing denials of coverage or care. 3. Financial incentives for UM decision makers do not encourage decisions that result in underutilization. Monthly UM Logs Annual audit of IPA policies and procedures, workplan, program, committee meetings and Ownership and Control documentation. Monthly log and focused denial and approval file selection review. See Corrective Action Plan (CAP) Requirements in MC_25 A4.
