Managed Care Services Clause Samples
The Managed Care Services clause defines the responsibilities and scope of services provided by a party, typically a healthcare provider or administrator, in managing and coordinating healthcare for covered individuals. This clause outlines the specific managed care activities, such as utilization review, case management, and provider network management, that the service provider must perform. By clearly delineating these duties, the clause ensures that both parties understand the expectations for care coordination and cost control, ultimately aiming to improve healthcare outcomes while managing expenses.
Managed Care Services. CCMSI will provide the Client with managed care services (comp mc™) upon mutual agreement of the parties. The Schedule of Managed Care Services to be provided is attached hereto as Exhibit D.
Managed Care Services. The parties acknowledge and agree that certain managed care provider agreements are in force between and amongst PCA P&C, Physician Corp. and various affiliated companies for the provision of such managed care services through the Network of Physician Corp. and its affiliated companies. "Network(s)" shall mean a preferred health care provider program or health care delivery system duly certified and/or approved by AHCA pursuant to Section 440.134 (1994), Florida Statutes. As delineated more fully in this provision, TPA shall continue to provide and maintain such workers' compensation managed care services through the Network as offered by PCA P&C under the Policies, for the benefit of the insured employees, in accordance with applicable state law. The managed care services provided under the managed care arrangement shall include, but not be limited to, the following:
Managed Care Services. When applicable under the Plan, the Claims Administrator will exercise the discretionary authority to make determinations that are necessary or appropriate for Case Management, Disease Management, Care Coordination, and other similar Managed Care Programs.
Managed Care Services. Contractor and Contractors’ dedicated staff shall be prepared and ready to commence provision of Managed Care Services to all County Workers Compensation claims as of July 1, 2024. Contractor shall provide services more specifically detailed below. The staffing plan shall be structured to ensure the County’s claims are administered in compliance with all rules and regulations governing the administration of a self-insured employer pursuant to Section 3700-3747, etc. seq. of the California Labor Code and California Administrative Procedures Act California Government Code, Title 8. File closures must conform to the California Administrative Code Section 15400.2.
Managed Care Services. OMNI shall use its best efforts to provide the following services to the Physician:
Managed Care Services. 1. QM/QI PROGRAM. RPO agrees and shall cause RPO Providers to comply with Texas HealthSpring's QM/QI Program and the provisions of Section 2.13 of this Agreement and consult with Texas HealthSpring in development of such program. RPO and RPO Provider acknowledge that Texas HealthSpring is required under the Medicare+Choice Program to have an agreement with an independent quality review and improvement organization approved by CMS to perform an external review of Texas HealthSpring's QM/QI Program. RPO agrees and shall cause RPO Providers to comply with the activities of Texas HealthSpring's independent quality review and improvement organization in accordance with the applicable Medicare+Choice Program requirements, including, without limitation, (a) allocating adequate space at RPO and RPO Provider's facilities for use of the review organization whenever it is conducting review activities; and (b) providing all pertinent data, including without limitation, patient care data, at the time the review organization needs the data to carry out the review and make its determination.
Managed Care Services