Common use of Utilization Review Clause in Contracts

Utilization Review. 13 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 to review and evaluate a random selection of PARTICIPANT case records. The 16 review shall include, but is not limited to, an evaluation of the necessity 17 and appropriateness of services provided and length of services. PARTICIPANT 18 cases to be reviewed shall be randomly selected by ADMINISTRATOR. 19 8.2 In the event CONTRACTOR and ADMINISTRATOR are unable to resolve 20 differences of opinion regarding the necessity and appropriateness of services 21 and length of services, the dispute shall be submitted to COUNTY’s Director of 22 Children and Family Services for final resolution.

Appears in 2 contracts

Samples: Services Agreement, Agreement for the Provision of Services

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Utilization Review. 13 8.1 6 10.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 7 request at CONTRACTOR’s facility identified in Paragraph 6 7 of this Exhibit A, 15 A 8 to review and evaluate a random selection of PARTICIPANT case records. The 16 9 review shall include, but is not limited to, : an evaluation of the necessity 17 and appropriateness of services provided necessity, 10 appropriateness, and length of servicesservices provided. PARTICIPANT 18 cases to be 11 reviewed shall be randomly selected by ADMINISTRATORCOUNTY. 19 8.2 12 10.2 In the event CONTRACTOR and ADMINISTRATOR are unable to resolve 20 13 differences of opinion regarding the necessity and appropriateness of services 21 necessity, appropriateness, and length of services14 services provided, the dispute shall be submitted to COUNTY’s Director of 22 15 Children and Family Services for final resolution.

Appears in 1 contract

Samples: Agreement for the Provision of Services

Utilization Review. 13 8.1 10.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 request at CONTRACTOR’s facility identified in Paragraph 6 7 of this Exhibit A, A 15 to review and evaluate a random selection of PARTICIPANT case records. The 16 review shall include, but is not limited to, : an evaluation of the necessity necessity, 17 and appropriateness of services provided appropriateness, and length of servicesservices provided. PARTICIPANT 18 cases to be 18 reviewed shall be randomly selected by ADMINISTRATORCOUNTY. 19 8.2 10.2 In the event CONTRACTOR and ADMINISTRATOR are unable to resolve 20 differences of opinion regarding the necessity and appropriateness of services 21 necessity, appropriateness, and length of services21 services provided, the dispute shall be submitted to COUNTY’s Director of 22 Children and Family Services for final resolution.

Appears in 1 contract

Samples: Agreement for the Provision of Services

Utilization Review. 13 24 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATORADMINSTRATOR’s 14 25 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 26 to review and evaluate a random selection of PARTICIPANT case records. The 16 27 review shall include, but is not limited to, an evaluation of the necessity 17 28 and appropriateness of services provided and length of services. PARTICIPANT 18 1 cases to be reviewed shall be randomly selected by ADMINISTRATOR. 19 2 8.2 In the event CONTRACTOR and ADMINISTRATOR are unable to resolve 20 3 differences of opinion regarding the necessity and appropriateness of services 21 4 and length of services, the dispute shall be submitted to COUNTY’s Director of 22 5 Children and Family Services for final resolution.

Appears in 1 contract

Samples: Services Agreement

Utilization Review. 13 19 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 20 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 21 to review and evaluate a random selection of PARTICIPANT case records. The 16 22 review shall include, but is not limited to, an evaluation of the necessity 17 23 and appropriateness of services provided and length of services. PARTICIPANT 18 24 cases to be reviewed shall be randomly selected by ADMINISTRATOR. 19 25 8.2 In the event CONTRACTOR and ADMINISTRATOR are unable to resolve 20 26 differences of opinion regarding the necessity and appropriateness of services 21 27 and length of services, the dispute shall be submitted to COUNTY’s Director of 22 28 Children and Family Services for final resolution.

Appears in 1 contract

Samples: Service Agreement

Utilization Review. 13 8.1 15 10.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 16 request at CONTRACTOR’s facility identified in Paragraph 6 7 of this Exhibit A, 15 A 17 to review and evaluate a random selection of PARTICIPANT case records. The 16 18 review shall include, but is not limited to, : an evaluation of the necessity 17 and appropriateness of services provided necessity, 19 appropriateness, and length of servicesservices provided. PARTICIPANT 18 cases to be 20 reviewed shall be randomly selected by ADMINISTRATORCOUNTY. 19 8.2 21 10.2 In the event CONTRACTOR and ADMINISTRATOR are unable to resolve 20 22 differences of opinion regarding the necessity and appropriateness of services 21 necessity, appropriateness, and length of services23 services provided, the dispute shall be submitted to COUNTY’s Director of 22 24 Children and Family Services for final resolution.

Appears in 1 contract

Samples: Service Agreement

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Utilization Review. 13 21 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 to 23 review and evaluate a random selection of PARTICIPANT case records. The 16 24 review shall include, but is not limited to, an evaluation of the necessity 17 25 and appropriateness of services provided and length of services. PARTICIPANT 18 26 cases to be reviewed shall be randomly selected by ADMINISTRATOR. 19 27 8.2 In the event CONTRACTOR and ADMINISTRATOR are unable to resolve 20 28 differences of opinion regarding the necessity and appropriateness of services 21 1 and length of services, the dispute shall be submitted to COUNTY’s Director of 22 2 Children and Family Services for final resolution. 3 9. SUSTAINABILITY

Appears in 1 contract

Samples: Services Agreement

Utilization Review. 13 12 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 request 13 at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 to 14 review and evaluate a random selection of PARTICIPANT case records. The 16 15 review shall include, but is not limited to, an evaluation of the necessity 17 16 and appropriateness of services provided and length of services. PARTICIPANT 18 17 cases to be reviewed shall be randomly selected by ADMINISTRATOR. 19 18 8.2 In the event CONTRACTOR and ADMINISTRATOR are unable to resolve 20 19 differences of opinion regarding the necessity and appropriateness of services 21 20 and length of services, the dispute shall be submitted to COUNTY’s Director of 22 21 Children and Family Services for final resolution.

Appears in 1 contract

Samples: Agreement for the Provision of Services

Utilization Review. 13 11 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 12 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 13 to review and evaluate a random selection of PARTICIPANT case records. The 16 14 review shall include, but is not limited to, an evaluation of the necessity 17 15 and appropriateness of services provided and length of services. PARTICIPANT 18 16 cases to be reviewed shall be randomly selected by ADMINISTRATOR. 19 17 8.2 In the event CONTRACTOR and ADMINISTRATOR are unable to resolve 20 18 differences of opinion regarding the necessity and appropriateness of services 21 19 and length of services, the dispute shall be submitted to COUNTY’s Director of 22 20 Children and Family Services for final resolution.

Appears in 1 contract

Samples: Services Agreement

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