Utilization Management and Quality Improvement Sample Clauses

Utilization Management and Quality Improvement. HPN shall make available to Provider information concerning utilization management and quality improvement plans administered by HPN or Payers and any modification thereof.
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Utilization Management and Quality Improvement. SelectCare shall make available to Provider information concerning utilization management and quality improvement plans administered by SelectCare. Any modifications to the utilization management and quality improvement plans shall be given to Provider at least thirty (30) days prior to the effective date of the modification.
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Utilization Management and Quality Improvement. THP shall provide Agent with written information concerning the utilization management and quality improvement programs administered by THP or Payor with respect to each Payor Plan for which a Provider is a Panel Provider and any modifications thereto. Agent shall be responsible for furnishing such information to Providers. THP will develop and market to Payors a utilization management and quality improvement plan for adoption as part of Payor Plans, based on the utilization management and quality improvements developed by THP, but THP shall have no obligation to require that such programs be included in a Payor Plan, such determination to be made by Payor.
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Utilization Management and Quality Improvement. TMHC shall provide Provider with written information concerning utilization management, quality improvement, and complaint resolution plans administered by TMHC or a Payer and any modifications thereto.
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Utilization Management and Quality Improvement. PMC or Payer shall make available to Provider information concerning utilization management, referrals, authorizations, denials, and quality improvement issues as administered by PMC or Payers.
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Utilization Management and Quality Improvement. PP/PPG agrees to follow and be bound by all federal and state laws and regulations and to comply with, participate in, and be bound by all policies, procedures, and protocols as set forth in Plan’s Quality Improvement Plan and Provider Manual, both as may be amended from time to time in Plan’s sole discretion, and such other policies, procedures and protocols established from time to time by Plan and by any State or Federal agency with respect to quality assurance, Covered Services, claims processing and review, utilization control, patient confidentiality and peer review. PP/PPG hereby acknowledges, understands and agrees that Plan will periodically modify or amend policies, procedures, and protocols governing Utilization Management and Quality Improvement and Plan agrees to notify PP/PPG of such changes thirty (30) days prior to implementation of such changes.
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