Quality; Utilization Management. Pursuant to any applicable provider manuals and related protocols, or as elsewhere specified under the Agreement, Provider agrees to cooperate with United’s quality improvement and management programs, utilization review and management programs, and provider sanctions programs. This shall include, but not be limited to, participation in any internal and external quality assurance, utilization review, peer review, and grievance procedures established by United or as required under the State Contract to ensure that Covered Persons have due process for their complaints, grievances, appeals, fair hearings or requests for external review of adverse decisions made by United or Provider. Provider shall adhere to the quality assurance and utilization review standards of the State Program and shall monitor quality and initiate corrective action to improve quality consistent with the generally accepted level of care. None of the above references programs or activities shall override the professional or ethical responsibility of the Provider or interfere with the Provider’s ability to provide information or assistance to their patients.
Appears in 4 contracts
Sources: Provider Agreement, Provider Agreement, Provider Agreement