Utilization/Care Management Program Sample Clauses
Utilization/Care Management Program. PPG and Member Physicians agree to participate in and cooperate fully with the provisions and all decisions rendered in connection with FHS’ Utilization/Care Management Program. PPG and Member Physician agrees to render Covered Services at the most appropriate level of service (including levels of acute care such as intensive care unit services or regular acute medical and surgical services as determined by the clinical status of the Member) which can safely be provided to the Member. For hospitalization, this means that the Member requires acute care as an inpatient due to the nature of the services the Member is receiving, or the severity of the Member’s condition, and that safe and adequate care cannot be received as an outpatient or at a less intensified medical setting. PPG and Member Physicians also agree to provide such records and other information as may be required or requested under such Utilization/Care Management Program as set forth in the Operations Manual. FHS may, at its sole discretion, delegate certain Utilization/Care Management Program activities. If so determined qualified and delegated by FHS, the obligations of PPG for delegation shall be as set forth herein.
Utilization/Care Management Program. A program that meets FHS’ standards and is approved by FHS and designed to review and manage the utilization of Covered Services, as described more fully in the Operations Manual.
Utilization/Care Management Program. A program that meets HNI's standards and is approved by HNI and designed to review and manage the utilization of Covered Services, as described in the Operations Manual.
Utilization/Care Management Program. PROVIDER and Participating Providers agree to participate in and cooperate fully with the provisions and all decisions rendered in connection with HNI's Utilization/Care Management Program. PROVIDER and Participating Provider agrees to render Covered Services at the most appropriate level of service. PROVIDER and Participating Providers also agree to provide medical records and other information as may be required or requested under such Utilization/Care Management Program as set forth in the Operations Manual. HNI may, at its sole discretion, delegate certain Utilization/Care Management Program activities. If so determined qualified and delegated by HNI, the obligations of PROVIDER for delegation shall be as set forth herein.