Common use of Utilization Management and Quality Assurance Programs Clause in Contracts

Utilization Management and Quality Assurance Programs. Pursuant to participation in Crescent’s or Payor’s Medical Management Programs, Provider agrees to cooperate with and participate in reasonable utilization management and quality assessment programs developed by Crescent, or by a Payor or TPA for related Plan(s), and understands that failure to comply with applicable utilization requirements may result in reductions of payment to Provider, depending on the applicable program or Plan. Crescent shall, and shall contractually require Payor to, define a reasonable process by which Provider can appeal any reduction(s) in payment made pursuant to Crescent’s or Payor’s Medical Management or utilization management programs.

Utilization Management and Quality Assurance Programs. Pursuant to participation in Crescent’s or Payor’s Medical Management Programs, Provider Facility agrees to cooperate with and participate in reasonable utilization management and quality assessment programs developed by Crescent, or by a Payor or TPA for related Plan(s), and understands that failure to comply with applicable utilization requirements may result in reductions of payment to ProviderFacility, depending on the applicable program or Plan. Crescent shall, and shall contractually require Payor to, define a reasonable process by which Provider Facility can appeal any reduction(s) in payment made pursuant to Crescent’s or Payor’s Medical Management or utilization management programs.

Utilization Management and Quality Assurance Programs. Pursuant to participation in Crescent’s or Payor’s Medical Management Programs, Provider Physician agrees to cooperate with and participate in reasonable utilization management and quality assessment programs developed by Crescent, or by a Payor or TPA for related Plan(s), and understands that failure to comply with applicable utilization requirements may result in reductions of payment to ProviderPhysician, depending on the applicable program or Plan. Crescent shall, and shall contractually require Payor to, define a reasonable process by which Provider Physician can appeal any reduction(s) in payment made pursuant to Crescent’s or Payor’s Medical Management or utilization management programs.