UM Program definition

UM Program means CalOptima’s Utilization Management Program.
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UM Program means either the utilization management program established and administered by KHF or the utilization management program required by a Payer in a Payer Agreement or required by an entity pursuant to an Agreement with KHF.
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UM Program means PHCP's utilization management program, which is part of the QI Program, and involves a comprehensive effort to monitor and manage the effective, efficient and timely use of health care services. The UM Program, at a minimum, shall satisfy the utilization management requirements of the Maryland Medicaid Managed Care Program. ARTICLE II - MARYLAND MEDICAID MANAGED CARE PROGRAM A. INTERPRETATION AND ENFORCEMENT OF STANDARDS, POLICIES, AND PROCEDURES. Notwithstanding anything in this Agreement to the contrary, with respect to all Benchmarks, standards, and PHCP and Prudential relevant policies, procedures and guidelines of general application ("PHCP Policies and Procedures") which JHMSC has agreed to comply with, follow and implement under this Agreement (including, but not limited to, those set forth in this Article II and in Article IV), the following numbered principles under this Article II, Section A shall govern and control the interpretation, application and enforcement of those Benchmarks, standards, and PHCP Policies and Procedures ("Compliance Activities"): 1. It is the express intention and desire of the parties that JHMSC begin to perform all of the JHMSC Services not later than January 1, 1997, or, in the event that, despite both parties' best efforts, such deadline is missed for any of the JHMSC Services, then as soon after January 1, 1997 as reasonably possible. Further, it is the express intention and desire of the parties that JHMSC continue the performance of JHMSC Services on an uninterrupted basis throughout the term of this Agreement. Should such performance be interrupted notwithstanding the parties' best efforts to maintain uninterrupted performance, then the parties desire and intend that JHMSC's performance of JHMSC Ser-
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Examples of UM Program in a sentence

  • Continuing Care Coordinators work within the Kaiser Permanente UM Program.

  • The Contractor shall have a Utilization Management (UM) Program assuring that beneficiaries have appropriate access to SUD services; medical necessity has been established, the beneficiary is at the appropriate ASAM level of care, and that the interventions are appropriate for the diagnosis and level of care.

  • IEHP is responsible for maintaining a monitoring system for UM Program oversight.

  • The committee shall also be responsible for monitoring patterns of care, isolating inappropriate utilization and performing other management and review duties as specified in the UM Program.

  • The UM Program shall be maintained in accordance with the requirements of State and Federal Law and the standards of Accreditation Organizations.

  • The Medical Director and Behavioral Health Director shall supervise the UM Program and shall be accessible and available for consultation as needed.

  • The Semi-Annual report due in February must also include the UM Program Annual Evaluation that is the IPA’s evaluation of the overall effectiveness of the UM Program, including whether or not goals were met.C. Annual Reporting Requirements: The following reports must be submitted annually to IEHP by the last day of February of each calendar year:1.

  • The Contractor shall implement a Utilization Management (UM) Program that meets the requirements set forth in this section and that is documented in a plan as defined in KRS 304.17A- 600.

  • Care’s UM Program is to ensure and facilitate the provision of appropriate medical and behavioral health care and services to L .A .

  • Linkage between the UM Program and the QI Program is supported through committee representation by UM Program management andby presenting executive level summary of pertinent UM documents to the L .A .

Related to UM Program

  • O&M Program is defined in Section 18(a).

  • AML Program has the meaning ascribed thereto in Schedule 2.1(F)(8) hereof.

  • CRAF Program means the Civil Reserve Air Fleet Program authorized under 10 U.S.C. Section 9511 et seq. or any similar or substitute program under the laws of the United States.

  • Custom program means a computer program which is specifically designed and developed only for

  • (3) PROGRAM.—The term program’ means

  • PACE Program means a program implemented by a municipality to stimulate energy efficiency and renewable energy projects in conformity with Act 270.

  • Development Plans means a coherent set of operations defined and financed exclusively by the OCTs in the framework of their own policies and strategies of development, and those agreed upon between an OCT and the Member State to which it is linked;

  • Program Plan means the tobacco settlement program plan dated February 14, 2001, including exhibits to the program plan, submitted by the authority to the legislative council and the executive council, to provide the state with a secure and stable source of funding for the purposes designated by section 12E.3A and other provisions of this chapter.

  • Development Program means the implementation of the development plan.

  • Pilot program means the pilot program identified and funded through the Funding Agreement and described in that Funding Agreement and its attachments.

  • Intensive supervision program means a parole program that

  • Covered Program means an education program or activity over which the College exercised substantial control over both the Respondent and the context in which the sexual harassment occurred.

  • Marketing program means a program established by order of the director pursuant to this act prescribing rules and regulations governing the marketing for processing, distributing, selling, or handling an agricultural commodity produced in this state or agricultural commodity input during a specified period and

  • Project Implementation Manual or “PIM” means the manual setting out the measures required for the implementation of the Project, as the same may be amended from time to time, subject to prior approval of the Association;

  • Development Plan has the meaning set forth in Section 3.2.

  • Collaborative pharmacy practice agreement means a written and signed

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • Approved program or "approved state" means a state or interstate program that has been approved or authorized by EPA under 40 CFR Part 123 (2000).

  • the Programme means the programme leading to the Degree of Master of Laws – LL.M – in International Maritime Law;

  • E-Verify Program above means the employment verification program administered by the United States Department of Homeland Security, the Social Security Administration, or any successor program.

  • Marketing Plan has the meaning set forth in Section 4.3(a).

  • Program means the statutorily authorized activities of the System Agency under which this Contract has been awarded.

  • Apprenticeship program means a program registered with the U.S. Department of Labor, Office of Apprenticeship, which includes terms and conditions for the qualification, recruitment, selection, employment, and training of apprentices, including the requirement for a written apprenticeship agreement.

  • Commercialization Plan has the meaning set forth in Section 6.2.

  • Educational program means a program for educating and preparing physician assistants which is approved by the board.

  • Quality Management Plan means the portion of the Project Development Plan providing the information requested in Section 4.3 of Exhibit B to the ITP.