Common use of Utilization Management Clause in Contracts

Utilization Management. Providers shall cooperate and participate in Health Plan’s utilization review and case management programs. Health Plan’s utilization review/case management programs may include provisions for (a) verification of eligibility and prior authorization for Covered Services, (b) concurrent and retrospective reviews, (c) requirements regarding referrals to third party Participating Providers, and (d) corrective action plans.

Utilization Management. Providers shall cooperate and participate in Health Plan’s utilization review and case management programs. Health Plan’s utilization review/case management programs may include provisions for (a) verification of eligibility and prior authorization for Covered Services, (b) concurrent and retrospective reviews, (c) requirements regarding referrals to third party Participating Providers, including those that are party to Carve Out Agreements and (d) corrective action plans.

Utilization Management. Providers shall cooperate and participate par ticipate in Health Plan’s utilization review and case management programs. Health Plan’s utilization review/case management programs may include provisions for (a) verification of eligibility and prior authorization au thorization for Covered Services, (b) concurrent and retrospective reviews, (c) requirements regarding regard ing referrals to third party Participating Providers, including those that are party to Carve Out Agreements and (d) corrective action plans.

Utilization Management. Providers shall cooperate and participate in Health Plan’s utilization review and case management programs. Health Plan’s utilization review/case management programs may include provisions for (a) verification of eligibility and prior authorization for Covered Services, (b) concurrent and retrospective reviews, and (c) requirements regarding referrals to third party Participating Providers, and (d) corrective action plans.