Quality and Network Management Sample Clauses

Quality and Network Management. At Risk Enrollees; Attachment 7, Section 5.04 Performance expectation to be determined in collaboration with QHPs based on 2014 measurement with preliminary target of exceeding QHP 50th percentile to avoid penalty NOTE: for 2014 measurement year/2015 penalty/credit assessment, track and report to QHPs only;5% penalty at risk thereafter (2015 measurement and beyond) Group 4: Covered California Performance Standards for Covered California Potential 25% Credit Customer Service Measures Covered California Performance Requirements
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Quality and Network Management. Health Assessment Year 1- Track only; Year 2-3 performance measure based on Year 1 determined performance with preliminary target of exceeding QHP 50th percentile to avoid penaltyExpectation: Completion of Health Assessment annually- 5% of total performance penalty at risk. Performance Level: <30%- 5% performance penalty. 30-50%- no penalty. 50% or greater- 5% performance credit.
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Quality and Network Management. New Care Models Year 1- Track only; Year 2-3 performance measure based on Year 1 determined performance with preliminary target of exceeding QHP 50th percentile to avoid penaltyExpectation: Increase in Covered California enrollees obtaining care through new care models- 5% of total performance penalty at risk. Performance Level: 0-5% increase- 5% performance. 5-10% increase- no penalty. 10% percent increase- 5% performance credit Appendix - Computation of Performance Measurement Standards [to be attached] Attachment 165 Business Associate Agreement BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (this “Agreement”) dated , 2013 between the California Health Benefit Exchange (“Covered Entity”) and (“Business Associate”) is entered into in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as codified at 42 U.S.C. §1320d-d8, and its implementing regulations at 45 C.F.R. Parts 160, 162 and 164 (the “HIPAA Regulations”) and attendant guidance; and the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009, and its attendant regulations and guidance (the “HITECH Act”). HIPAA, the HIPAA Regulations and the HITECH Act are sometimes referred to collectively herein as “HIPAA Requirements.”
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Quality and Network Management. Quality Reporting System (QRS)- Getting the Right Care; related to Attachment 7, Section 3.01. Specific measures noted in Appendix 1 to this Attachment 14. Expectation: Getting the Right Care- HEDIS/CAHPS Clinical Effectiveness measure set summary (Product type reporting)- 106.255% of total performance requirement expected. Performance Level: <50th PCT:105% penalty;51-75th PCT: no penalty; >75th PCT: 105% performance credit (vs. national HMO benchmark). 3.32 Quality and Network Management –Quality Reporting System (QRS)- Access to Care; related to Attachment 7, Section 3.01. Specific measures noted in Appendix 1 to this Attachment 14. Expectation: Access to Care- HEDIS/CAHPS measure set summary (Product type reporting): 106.255% of total performance requirement expected. Performance Level: <50th PCT:105% penalty;51-75th PCT: no penalty; >75th PCT: 105% performance credit (vs. national HMO benchmark). 3.43
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Quality and Network Management. Preventive Health and Wellness; Attachment 7, Section 4.01. Performance expectation to be determined in collaboration with QHPs based on 2014 measurement with preliminary target of exceeding QHP 50th percentile to avoid penalty NOTE: for 2014 measurement year/2015 penalty/credit assessment, track and report to QHPs only;5% penalty at risk thereafter (2015 measurement and beyond) Year 1- Track only; Year 2-3 performance measure based on Year 1 determined performance with preliminary target of exceeding QHP 50th percentile to avoid penalty
Sample 1
Quality and Network Management. Quality Reporting System -– (QRS) - Access to Care- HEDIS/CAHPS measure set summary Expectation: Access to Care - HEDIS/CAHPS measure set summary (product type reporting) - 10% of total performance requirement expected. Access to Care Getting Care Quickly Composite (CAHPS) Getting Needed Care Composite (CAHPS) Child and Adolescent Access to Primary Care Practitioners (12-14, 25mo-6yr, 7-11, 12-19) HEDIS Adults' Access to Preventive/Ambulatory Health Services (20 to 44 years and 45 to 64 years) HEDIS *certain CAHPS measures may not be available for all Product Types
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Related to Quality and Network Management

  • Quality Management System Supplier hereby undertakes, warrants and confirms, and will ensue same for its subcontractors, to remain certified in accordance with ISO 9001 standard or equivalent. At any time during the term of this Agreement, the Supplier shall, if so instructed by ISR, provide evidence of such certifications. In any event, Supplier must notify ISR, in writing, in the event said certification is suspended and/or canceled and/or not continued.

  • Telemedicine Services This plan covers clinically appropriate telemedicine services when the service is provided via remote access through an on-line service or other interactive audio and video telecommunications system in accordance with R.I. General Law § 27-81-1. Clinically appropriate telemedicine services may be obtained from a network provider, and from our designated telemedicine service provider. When you seek telemedicine services from our designated telemedicine service provider, the amount you pay is listed in the Summary of Medical Benefits. When you receive a covered healthcare service from a network provider via remote access, the amount you pay depends on the covered healthcare service you receive, as indicated in the Summary of Medical Benefits. For information about telemedicine services, our designated telemedicine service provider, and how to access telemedicine services, please visit our website or contact our Customer Service Department.

  • Quality Management Grantee will:

  • Information Technology Enterprise Architecture Requirements If this Contract involves information technology-related products or services, the Contractor agrees that all such products or services are compatible with any of the technology standards found at xxxxx://xxx.xx.xxx/iot/2394.htm that are applicable, including the assistive technology standard. The State may terminate this Contract for default if the terms of this paragraph are breached.

  • Information Services Traffic 5.1 For purposes of this Section 5, Voice Information Services and Voice Information Services Traffic refer to switched voice traffic, delivered to information service providers who offer recorded voice announcement information or open vocal discussion programs to the general public. Voice Information Services Traffic does not include any form of Internet Traffic. Voice Information Services Traffic also does not include 555 traffic or similar traffic with AIN service interfaces, which traffic shall be subject to separate arrangements between the Parties. Voice Information services Traffic is not subject to Reciprocal Compensation as Local Traffic under the Interconnection Attachment.

  • Network Management 60.1 CLEC and CenturyLink will exchange appropriate information (e.g., network information, maintenance contact numbers, escalation procedures, and information required to comply with requirements of law enforcement and national security agencies) for network management purposes. In addition, the Parties will apply sound network management principles to alleviate or to prevent traffic congestion and to minimize fraud associated with third number billed calls, calling card calls, and other services related to this Agreement.

  • Quality Assurance The parties endorse the underlying principles of the Company’s Quality Management System, which seeks to ensure that its services are provided in a manner which best conforms to the requirements of the contract with its customer. This requires the Company to establish and maintain, implement, train and continuously improve its procedures and processes, and the employees to follow the procedures, document their compliance and participate in the improvement process. In particular, this will require employees to regularly and reliably fill out documentation and checklists to signify that work has been carried out in accordance with the customer’s specific requirements. Where necessary, training will be provided in these activities.

  • Online Services Microsoft warrants that each Online Service will perform in accordance with the applicable SLA during Customer’s use. Customer’s remedies for breach of this warranty are in the SLA. The remedies above are Customer’s sole remedies for breach of the warranties in this section. Customer waives any breach of warranty claims not made during the warranty period.

  • Quality Assurance Plan The contractor shall develop and submit to NMFS a contractor Quality Assurance Plan, as referenced in Section F.5.3, which details how the contractor will ensure effectiveness and efficiency of collection efforts as well as the quality of data collected by its At-Sea Monitors. The contractor shall further establish, implement, and maintain a Quality Assurance Management program to ensure consistent quality of all work products and services performed under this contract.

  • Information Technology Accessibility Standards Any information technology related products or services purchased, used or maintained through this Grant must be compatible with the principles and goals contained in the Electronic and Information Technology Accessibility Standards adopted by the Architectural and Transportation Barriers Compliance Board under Section 508 of the federal Rehabilitation Act of 1973 (29 U.S.C. §794d), as amended. The federal Electronic and Information Technology Accessibility Standards can be found at: xxxx://xxx.xxxxxx-xxxxx.xxx/508.htm.

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