Utilization Review and Quality Assurance. If while completing the Utilization Review and Quality Assurance requirements of this Exhibit A, Attachment I, any of the Contractor’s skilled professional medical and personnel directly supporting staff meet the criteria set forth in 42 CFR 432.50(d)(1), then the Contractor shall submit a written request that specifically demonstrates how the skilled professional medical personnel and directly supporting staff meet all of the applicable criteria set forth in 42 CFR 432.50(d)(1) and outlines the duties they shall perform to assist DHCS, or DHCS’s skilled professional medical personnel, in activities that are directly related to the administration of the DMC Program. DHCS shall respond to the Contractor’s written request within 20 days with either a written agreement pursuant to 42 CFR 432.50(d)(2) approving the request or a written explanation as to why DHCS does not agree that the Contractor’s skilled professional medical personnel and directly supporting staff do not meet the criteria set forth in 42 CFR 432.50(d)(1).
Utilization Review and Quality Assurance. 1. The INSURER will establish a Quality of Care Program with the following guidelines:
Utilization Review and Quality Assurance. Provider shall cooperate fully with Plan’s Utilization Review and Quality Assurance Programs or such other Utilization Review and Quality Assurance Programs designated by Plan as set forth in the Provider Handbook. Failure to do so shall be deemed a material breach of this Agreement.
Utilization Review and Quality Assurance. 1. The MBHO will establish a Quality of Care Program with the following guidelines:
Utilization Review and Quality Assurance. Employee shall practice in a manner consistent with, and remain subject to, any utilization or quality assurance review processes which Employer may institute in regard to its
Utilization Review and Quality Assurance. Each Provider shall, and shall cause its Subcontractors to, cooperate with DHP's efforts to implement reasonable utilization management and quality assurance programs to ensure the furnishing of high quality, cost-effective medically necessary services to Members, including active participation in office and hospital record audits, surveys, setting standards, investigation of Member complaints or grievances, continuing education, availability and continuity of care programs and utilization management and quality assurance committee meetings. Providers (including Subcontractors) shall also comply with administrative procedures and rules for utilization management and quality assurance as reasonably promulgated from time to time by DHP.
Utilization Review and Quality Assurance. 3.1 Provider shall, and shall cause each Contracting Provider to, actively participate in, support, and cooperate with any applicable utilization management and quality assurance (“UM/QA”) programs designated and approved by March Vision Care or the Plan. March Vision Care may establish one or more committees comprised of Contracting Providers and other individuals licensed to practice optometry and/or ophthalmology for purposes of carrying out the UM/QA programs designated and approved by March Vision Care under this Agreement. March Vision Care shall give Provider access via eyeSynergy® or other means to any applicable documentation of such programs and any amendments or modifications.
