Quality; Utilization Management. Provider agrees to participate and cooperate with any quality improvement, utilization review, and management activities established by United and/or the Division of TennCare, including actions to improve patient safety and quality. 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 applicable CRA 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.
Appears in 4 contracts
Sources: Tenncare Program Regulatory Requirements Appendix, Provider Agreement, Provider Agreement