External Review. Contractor shall comply with State and Federal laws, rules and regulations relating to the external review process, including independent medical review, available to Covered California Enrollees for Covered Services.

Appears in 29 contracts

Sources: Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract

Appears in 20 contracts

Sources: Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract

External Review. Contractor shall comply with State and Federal laws, rules and regulations relating to the external review ~~process~~Sprocess, including independent medical review, available to Covered California Enrollees for Covered Services.

Appears in 2 contracts

Sources: Covered California Qualified Health Plan Issuer Contract, Qualified Health Plan Issuer Contract

Related Clauses

Internal Review
Quoted Investments External Review
Unquoted Investments External Review
Annual Reviews
Annual Review

Parent Clauses

Customer Service Standards
Covered California Enrollee Appeals and Grievances
Enrollee Appeals and Grievances
Appeals Procedures
Review Procedures and How to Appeal a Claim Benefit

Sub-Clauses

Discount Guarantee Methodology
Retail Pharmacy Paid Claim Charge
Non-Best-In-Class Specialty Pharmacy Paid Claim Charge
Mail Pharmacy Paid Claim Charge

Common use of External Review Clause in Contracts