Utilization Review and Quality Assurance Sample Clauses

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).
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Utilization Review and Quality Assurance. 1. The INSURER will establish a Quality of Care Program with the following guidelines:
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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.
Sample 1
Utilization Review and Quality Assurance. 1. The MBHO will establish a Quality of Care Program with the following guidelines: a) PHYSICIAN-CREDENTIALING: The MBHO will establish and follow strict provider screening procedures before contracting. These procedures should substantially conform to current NCQA (National Commission for Quality Assurance) guidelines. In order to assure quality health services for the medically indigent, the MBHO will follow stringent physician selection and credentialing process for this plan as per the MBHO's Proposal. The ADMINISTRATION may review participating providers credentials at any time after reasonable notice and submit its findings to the MBHO for consideration by the MBHO if necessary. The MBHO shall notify the ADMINISTRATION quarterly of all accepted and non-accepted providers.
Sample 1
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
Sample 1
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. 3.2 Provider shall (and shall cause each Contracting Provider to) cooperate with and abide by and adhere to rulings of the March Vision Care committees, and further agrees that upon request, Provider will furnish case records of March Vision Care patients for whom claims have been submitted, and that March Vision Care may use any information so obtained for statistical, actuarial, scientific, peer review or other reasonable purposes, provided that the committee shall maintain the confidentiality of such information in accordance with applicable State and federal laws and regulations.
Sample 1
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.
Sample 1
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Related to Utilization Review and Quality Assurance

  • Quality Assurance/Quality Control Contractor shall establish and maintain a quality assurance/quality control program which shall include procedures for continuous control of all construction and comprehensive inspection and testing of all items of Work, including any Work performed by Subcontractors, so as to ensure complete conformance to the Contract with respect to materials, workmanship, construction, finish, functional performance, and identification. The program established by Contractor shall comply with any quality assurance/quality control requirements incorporated in the Contract.

  • COUNTY’S QUALITY ASSURANCE PLAN The County or its agent will evaluate the Contractor’s performance under this Contract on not less than an annual basis. Such evaluation will include assessing the Contractor’s compliance with all Contract terms and conditions and performance standards. Contractor deficiencies which the County determines are severe or continuing and that may place performance of the Contract in jeopardy if not corrected will be reported to the Board of Supervisors. The report will include improvement/corrective action measures taken by the County and the Contractor. If improvement does not occur consistent with the corrective action measures, the County may terminate this Contract or impose other penalties as specified in this Contract.

  • Quality Assurance The parties endorse the underlying principles of the Company’s Quality Management System, which seeks to ensure that its services are provided in a manner which best conforms to the requirements of the contract with its customer. This requires the Company to establish and maintain, implement, train and continuously improve its procedures and processes, and the employees to follow the procedures, document their compliance and participate in the improvement process. In particular, this will require employees to regularly and reliably fill out documentation and checklists to signify that work has been carried out in accordance with the customer’s specific requirements. Where necessary, training will be provided in these activities.

  • Quality Assurance Program An employee shall be entitled to leave of absence without loss of earnings from her or his regularly scheduled working hours for the purpose of writing examinations required by the College of Nurses of Ontario arising out of the Quality Assurance Program.

  • SMHS Governance, Safety and Quality Requirements 4.1 Participates in the maintenance of a safe work environment. 4.2 Participates in an annual performance development review. 4.3 Supports the delivery of safe patient care and the consumers’ experience including participation in continuous quality improvement activities in accordance with the requirements of the National Safety and Quality Health Service Standards and other recognised health standards. 4.4 Completes mandatory training (including safety and quality training) as relevant to role. 4.5 Performs duties in accordance with Government, WA Health, South Metropolitan Health Service and Departmental / Program specific policies and procedures. 4.6 Abides by the WA Health Code of Conduct, Occupational Safety and Health legislation, the Disability Services Act and the Equal Opportunity Act.

  • EMHS Governance, Safety and Quality Requirements 4.1 Participates in the maintenance of a safe work environment. 4.2 Actively participates in the Peak Performance program. 4.3 Supports the delivery of safe patient care and the consumers’ experience including participation in continuous quality improvement activities in accordance with the requirements of the National Safety and Quality Health Service Standards and other recognised health standards. 4.4 Completes mandatory training (including safety and quality training) as relevant to role. 4.5 Performs duties in accordance with the EMHS Vision and Values, WA Health Code of Conduct, Occupational Safety and Health legislation, the Disability Services Act and the Equal Opportunity Act and Government, WA Health, EMHS and Departmental / Program specific policies and procedures.

  • NMHS Governance, Safety and Quality Requirements 2.1 Participates in the maintenance of a safe work environment. 2.2 Participates in an annual performance development review. 2.3 Supports the delivery of safe patient care and the consumers’ experience including participation in continuous quality improvement activities in accordance with the requirements of the National Safety and Quality Health Service Standards and other recognised health standards. 2.4 Completes mandatory training (including safety and quality training) as relevant to role. 2.5 Performs duties in accordance with Government, WA Health, North Metropolitan Health Service and Departmental / Program specific policies and procedures. 2.6 Abides by the WA Health Code of Conduct, Occupational Safety and Health legislation, the Disability Services Act and the Equal Opportunity Act.

  • Quality Assurance Requirements There are no special Quality Assurance requirements under this Agreement.

  • Project Monitoring Reporting and Evaluation The Recipient shall furnish to the Association each Project Report not later than forty-five (45) days after the end of each calendar semester, covering the calendar semester.

  • Monitoring and Review The Provider agrees to allow access to the Department for purposes of monitoring and review. This access includes but is not limited to client records, fiscal records, staffing records, policy and procedural manuals, facilities, staff, and children in care of the Department. The Department will conduct quality reviews, which may include site-based quality review visits.

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