QUALITY IMPROVEMENT, UTILIZATION MANAGEMENT, PERFORMANCE IMPROVEMENT Sample Clauses

QUALITY IMPROVEMENT, UTILIZATION MANAGEMENT, PERFORMANCE IMPROVEMENT. 1. Doctor shall comply with all CCMI and health plan company procedures, including quality improvement, credentialing, medical management, treatment authorization, concurrent monitoring, peer review, utilization management, Enrollee complaint or grievance, remedial measures, and any other similar programs and procedures established by health plan companies and/or CCMI from time to time, including but not limited to the following: A. All treatment plans must be authorized and shall be subject to review by the Credentialing, Quality Improvement, peer review, and remedial measures committees of CCMI. CCMI and health plan companies have the right to verify the clinical accuracy of all submitted information and claims. Doctor shall be responsible for obtaining any authorization required to release medical information to CCMI or a health plan company. Doctor agrees to abide by the decisions of CCMI, including all authorization and review processes of CCMI and health plan companies. Doctor agrees that any act, omission, or decision for which review has not been requested in accordance with procedures established by CCMI, its designees, or health plan companies for review of such act, omission or decision is final. B. Doctor agrees to promptly notify CCMI in writing of all Enrollee or Enrollee related complaints received, and the resolution of the complaint, if any. If a complaint is not resolved by Doctor in a manner satisfactory to the Enrollee or complaining party, CCMI and/or health plan company will follow their procedures to resolve any such complaints. C. Doctor agrees to participate in and cooperate fully with such programs as are established by CCMI and/or health plan companies to assess, evaluate and improve: the ongoing performance of CCMI and its participating doctors related to the provision of health services; the provision of services designed to improve the health of Enrollees, Enrollee satisfaction or administrative efficiency; including without limitation, quality assurance, practice guidelines, health improvement, utilization management, and credentialing programs. Doctor understands and agrees that the credentialing processes of CCMI, its designees, and the health plan companies are audited periodically by health plan companies, CMS, NCQA, and other credentialing bodies on an ongoing basis as required by CMS regulations, and the requirements of the credentialing bodies. Doctor further understands and agrees that s/he must comply with all applic...