Common use of Blue Shield Monitoring and Oversight Clause in Contracts

Blue Shield Monitoring and Oversight. Blue Shield shall be entitled to conduct audits of Group’s compliance with the criteria and standards. Group shall provide reasonable access during regular business hours to its claims, claims supporting documentation, Member inquiry files, credentialing files, clinical and medical records of Members as applicable and reasonably necessary to evaluate Group’s performance of its delegated activities. In the event Group has insufficient data and records relating to Members to permit Blue Shield to evaluate a particular activity under review, then Group shall provide sufficient documents and information on non-Members, with all non-Member identifying information deleted to preserve the confidentiality of such information, in order to permit Blue Shield to evaluate Group’s performance of such activity. Group shall participate in an annual evaluation and quarterly meetings between Blue Shield and Group staff. In addition, Group shall provide to Blue Shield periodic reports on delegated activities as set forth in the Provider Manual. Group shall take such corrective actions as requested by Blue Shield through the audit review process within such time lines as established by Blue Shield.

Blue Shield Monitoring and Oversight. Blue Shield shall be entitled to conduct audits of Group’s compliance with the criteria and standards. Upon advance notice by Blue Shield, Group shall provide reasonable access during regular business hours to its claims, claims supporting documentation, Member inquiry files, credentialing files, clinical and medical records of Members as applicable and reasonably necessary to evaluate Group’s performance of its delegated activities. In the event Group has insufficient data and records relating to Members to permit Blue Shield to evaluate a particular activity under review, then Group shall provide sufficient documents and information on non-Members, with all non-Member identifying information deleted to preserve the confidentiality of such information, in order to permit Blue Shield to evaluate Group’s performance of such activity. Group shall participate in an annual evaluation and quarterly meetings between Blue Shield and Group staff. In addition, Group shall provide to Blue Shield periodic reports on delegated activities as set forth in the Provider Manual. Group shall take such corrective actions as requested by Blue Shield through the audit review process within such time lines as established by Blue Shield.