Utilization Review Compliance Sample Clauses

Utilization Review Compliance. (a) Participating Provider agrees to participate in and comply with the utilization review program adopted by the WPPA, to comply with its policies, rules, regulations and to participate in any grievance procedure established by the WPPA to resolve Participating Patient grievances. The WPPA's Utilization Review and Quality Assessment Program for preadmission, concurrent and retrospective utilization review follows the concepts of the Medical Society Medical Review Foundation program, utilizing the Interqual ISDA Guidelines, and is incorporated herein by reference. The program shall be available for review by Participating Physicians and Group at the places and times stated in Paragraph 5.3. The WPPA will notify Provider of its policies, rules, regulations and amendments to the review program not less than fifteen (15) days prior to the effective date thereof. (b) The Participating Provider acknowledges, in all events, that the Provider has an independent responsibility to provide good medical care to Participating Patients and that any action taken by the WPPA or Group pursuant to WPPA's utilization review program in no way absolves Provider from the responsibility to provide appropriate medical care to Participating Patients. Nothing in this agreement shall be in any manner with the methods or means by which a Participating Physician renders services to Participating Patients.