UM Program. County shall comply with CalOptima’s UM Program including: 3.3.1 County acknowledges and agrees that CalOptima has implemented and maintains a UM Program that addresses evaluations of Medical Necessity and processes to review and approve the provision of items and services, including Behavioral Health Services, to Members. County shall comply with the requirements of the UM Program including, without limitation, those criteria applicable to the Behavioral Health Services as described in this Contract. 3.3.2 County shall comply with all Prior Authorization, concurrent and retrospective review and authorization requirements as set forth in CalOptima Policies. 3.3.3 County Associates may not admit a Member to a hospital on a non-emergency basis without first receiving prior authorization from CalOptima’s UM Department. 3.3.4 County Associates shall permit CalOptima’s UM Department staff and other qualified representatives of CalOptima to conduct on site reviews of the medical records of Members. CalOptima staff shall notify County prior to conducting such on site reviews and shall wear appropriate identification.
Appears in 3 contracts
Sources: Coordination and Provision of Behavioral Health Care Services Contract, Coordination and Provision of Behavioral Health Care Services Contract, Coordination and Provision of Behavioral Health Care Services Contract