SUPPORT PARTICIPATING PHYSICIANS definition

SUPPORT PARTICIPATING PHYSICIANS. Doctors of Medicine legally authorized to practice medicine and surgery within Puerto Rico who are needed to complement and provide support services to the Primary Care Physicians and who have a contract with the INSURER to provide said services. A referral from the Gatekeeper is necessary. QUALITY IMPROVEMENT (QI): The ongoing process of responding to data gathered through quality monitoring efforts, in such a way as to improve the quality of health care delivered to individuals. This process necessarily involves follow-up studies of the measures taken to effect change in order to demonstrate that the desired change has occurred. UTILIZATION MANAGEMENT (UM): The process of evaluating necessity appropriateness and efficiency of healthcare services through the revision of information about hospital, service or procedure from patients and/or providers to determine whether it meets established guidelines and criteria approved by the MCO. ORGANIZATION AND ADMINISTRATION INSURER must maintain the organizational and administrative capacity and capabilities to carry out all duties and responsibilities under this contract. INSURER must maintain assigned staff with the capacity and capability to provide all services to all Beneficiaries under this contract. INSURER must maintain an administrative office in the service area (local office). The local office must comply with the American with Disabilities Act (ADA) requirements for public buildings. INSURER must provide training and development programs to all assigned staff to ensure they know and understand the service requirements under this contract including the reporting requirements, the policies and procedures, cultural and linguistic requirements and the scope of services to be provided. The training and development plan must be submitted to THE ADMINISTRATION. INSURER must notify THE ADMINISTRATION immediately no later than 30 days after the effective date of this contract of any changes in its organizational chart as previously submitted to THE ADMINISTRATION. INSURER must notify THE ADMINISTRATION immediately within fifteen (15) working days of any change in regional or office managers. This information must be updated whenever there is a significant change in organizational structure or personnel.
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SUPPORT PARTICIPATING PHYSICIANS. Doctors of Medicine legally authorized to practice medicine and surgery within Puerto Rico who are needed to complement and provide support services to the Primary Care Physicians and who have a contract with the INSURER to provide said services. A referral from the Gatekeeper is necessary.
Sample 1

Related to SUPPORT PARTICIPATING PHYSICIANS

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  • Participating Prosthetic Provider means a Prosthetic Provider who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

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