Medical Management Programs definition

Medical Management Programs means the reasonable customer satisfaction plans, quality management programs, utilization management programs, credentialing, rules and regulations, provider sanctions, grievance procedures, and other similar programs, procedures and protocols conducted by or on behalf of Payors and/or Crescent pursuant to this Agreement, the applicable Crescent Network Access Agreement and Crescent’s participating provider agreements with other Crescent Providers.
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Medical Management Programs shall have the meaning set forth in Section 8.4.
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Examples of Medical Management Programs in a sentence

  • The Contractor will provide an array of Disease Management Programs and Self-Help Medical Management Programs.

  • The Medical Management Programs are services that can help you coordinate your care and treatment.

  • Blue Shield’s Medical Management Programs work with your provider to ensure that your care is provided safely and effectively in a setting that is appropriate to your needs.

  • See the Medical Management Programs section for more information about prior authorization.

  • All Benefits are subject to: • Your Cost Share; • Any Benefit maximums; • The provisions of the Medical Management Programs; and • The terms, conditions, limitations, and exclusions of this Evidence of Coverage.

  • Please see the Medical Management Programs section for additional information on emergency admission notification.

  • Please see the Medical Management Programs section for additional information on prior authorization and the Emergency Benefits section for information on emergency admission notification.

  • Crescent or its designee may permit Payors and their designees to conduct Medical Management Programs and shall contractually require such entities to meet such legal and regulatory requirements.

  • All Medical Management Programs now or hereafter conducted directly by Crescent pursuant to this Agreement shall be conducted in a manner substantially consistent with all applicable Joint Commission and NCQA requirements, the requirements of the Healthcare Quality Improvement Act of 1986, as amended, and all other regulatory standards and criteria for such programs.

  • All Benefits are subject to:  Your Cost Share;  Any Benefit maximums;  The provisions of the Medical Management Programs; and  The terms, conditions, limitations, and exclusions of this Evidence of Coverage.