Utilization Management Plan Sample Clauses

Utilization Management Plan. Prior to the execution of this Agreement, and if utilization management functions are delegated to Group by Blue Shield, Group will provide Blue Shield with a written Utilization Management Plan for the purpose of review and approval by Blue Shield. Group shall notify Blue Shield within thirty (30) days of any changes involving the rules, regulations, authorities and responsibilities for the Utilization Management Plan, which shall be subject to reasonable approval thereof by Blue Shield. The Utilization Management Plan shall include procedures approved by Blue Shield to identify, assess, establish, and implement a treatment plan for Members who have complex or serious medical conditions, and for direct access of Members to services as mandated by the BBA and related regulations. Group agrees to comply with Blue Shield’s Medical Policies. All Group denial letters shall be reviewed and approved by Blue Shield. Group agrees to cooperate with Blue Shield in furnishing the required reports identified in the Provider Manual.”
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Utilization Management Plan. The Utilization Plan may not be structured in such a way as to provide incentives to individuals or entities to deny, limit, or discontinue medically necessary services
Sample 1
Utilization Management Plan. The OVHA shall develop and maintain a comprehensive Utilization Management Plan to identify potential over- and under-utilization of services. The Utilization Management Plan must conform to all applicable Federal and State regulations. The OVHA shall adopt program guidelines that are based on valid clinical evidence, or based on the consensus of health care professionals, consideration of the needs of the enrollees, and consultation with health care professionals who participate in the Global Commitment to Health Waiver and other program stakeholders. Program guidelines shall be reviewed and updated periodically as appropriate. The OVHA shall disseminate the guidelines to its subcontracted Departments and shall require the Departments to disseminate the guidelines among all of their designated providers. The OVHA shall not structure compensation for any entity that conducts utilization management services in such a way as to provide incentives for the denial, limitation or discontinuation of medically necessary services to any enrollee.
Sample 1
Utilization Management Plan. OPSS’s Utilization Management Plan, including the VA CCN Requirements relating thereto. The OPSS Utilization Management Plan, and Provider’s responsibilities and requirements relating thereto, are part of the OPSS Policies and are available to Provider in the Provider Manual.
Sample 1
Utilization Management Plan. DHVA must have in effect mechanisms to detect both underutilization and over utilization of services and to assess the quality and appropriateness of care furnished to enrollees with special health care needs. DVHA has delegated the function of assessing the quality and appropriateness of care furnished to beneficiaries with special health care needs to the Department of Aging and Independent Living (DAIL) and the Department of Mental Health (DMH). DVHA and its IGA partners, when applicable, shall adopt practice guidelines that are based on valid clinical evidence, or based on the consensus of health care professionals, consideration of the needs of the enrollees, and consultation with health care professionals who participate in the Global Commitment to Health Waiver and other program stakeholders. Program guidelines shall be reviewed and updated periodically as appropriate. DVHA shall disseminate guidelines in collaboration with its IGA partners and shall require the Departments to disseminate the guidelines among all of their designated providers. DVHA and its IGA partners make decision with regard to the following areas that are consistent with the practice guidelines: utilization management: enrollee education; coverage of services; and other areas to which the guidelines apply. DVHA shall not structure compensation for any entity that conducts utilization management services in such a way as to provide incentives for the denial, limitation or discontinuation of medically necessary services to any enrollee.
Sample 1

Related to Utilization Management Plan

  • Transportation Management Tenant shall fully comply with all present or future programs intended to manage parking, transportation or traffic in and around the Building, and in connection therewith, Tenant shall take responsible action for the transportation planning and management of all employees located at the Premises by working directly with Landlord, any governmental transportation management organization or any other transportation-related committees or entities.

  • Collaboration Management Promptly after the Effective Date, each Party will appoint a person who will oversee day-to-day contact between the Parties for all matters related to the management of the Collaboration Activities in between meetings of the JSC and will have such other responsibilities as the Parties may agree in writing after the Effective Date. One person will be designated by Merck (the “Merck Program Director”) and one person will be designated by Moderna (the “Moderna Program Director,”) together will be the “Program Directors”. Each Party may replace its Program Director at any time by notice in writing to the other Party. Any Program Director may designate a substitute to temporarily perform the functions of that Program Director by written notice to the other Party. The initial Program Directors will be: For Moderna: [***] For Merck: [***]

  • Program Management 1.1.01 Implement and operate an Immunization Program as a Responsible Entity

  • Agent’s Management Time Any amount payable to the Agent under Clause 14.3 (Indemnity to the Agent), Clause 16 (Costs and expenses) and Clause 25.10 (Lenders’ indemnity to the Agent) shall include the cost of utilising the Agent’s management time or other resources and will be calculated on the basis of such reasonable daily or hourly rates as the Agent may notify to the Parent and the Lenders, and is in addition to any fee paid or payable to the Agent under Clause 11 (Fees).

  • Construction Management Landlord or its Affiliate or agent shall supervise the Work, make disbursements required to be made to the contractor, and act as a liaison between the contractor and Tenant and coordinate the relationship between the Work, the Building and the Building’s Systems. In consideration for Landlord’s construction supervision services, Tenant shall pay to Landlord a construction supervision fee equal to three percent (3%) of Tenant’s Costs specified in Section 7.

  • Construction Management Fee The Construction Management Fee for the Project shall be either a ☒Lump Sum or ☐Not-To-Exceed Fee of Fifty-One Thousand, Four Hundred Fifty-Six Dollars and Twenty-Three Cents ($51,456.23). NOTE: Allowances will be on a Not-To-Exceed basis. All unused funds will be returned to the School District at the time of construction closeout. Fee will be paid only on cost of work for these items. Exhibit C- Project Assignment Page 2 of 4

  • Project Management Project Management Institute (PMI) certified project manager executing any or all of the following: • Development of Project Charter • Development of project plan and schedule • Coordination and scheduling of project activities across customer and functional areas • Consultation on operational and infrastructure requirements, standards and configurations • Facilitate project status meetings • Timely project status reporting • Address project issues with functional areas and management • Escalation of significant issues to customers and executive management • Manage project scope and deliverable requirements • Document changes to project scope and schedule • Facilitate and document project closeout

  • Account Management 15.1 The Contractor is required to provide a dedicated Strategic Account Manager who will be the main point of contact for the Authority. The Strategic Account Manager will:  Attend quarterly, or as otherwise agreed, review meetings with the Authority, in person at the Authority’s premises or other locations as determined by the Authority  Attend regular catch-up meetings with the Authority, in person or by telephone/videoconference  Resolve any on-going operational issues which have not been resolved by the Contractor or Account Manager(s) and therefore require escalation  Ensure that the costs involved in delivering the Framework are as low as possible, whilst always meeting the required standards of service and quality.

  • Virus Management Transfer Agent shall maintain a malware protection program designed to deter malware infections, detect the presence of malware within the Transfer Agent environment.

  • Change Management BellSouth provides a collaborative process for change management of the electronic interfaces through the Change Control Process (CCP). Guidelines for this process are set forth in the CCP document as amended from time to time during this Agreement. The CCP document may be accessed via the Internet at xxxx://xxx.xxxxxxxxxxxxxxx.xxxxxxxxx.xxx.

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