Utilization Data. The contractor shall conduct a quarterly analysis of utilization data, including inpatient utilization, and shall follow-up on cases of potential under- and over-utilization. Over- and under-utilization shall be determined based on comparison to established medical community standards. See Section A.7.7 of the Appendices (Table 5) for a description of utilization data to be submitted to the Department.
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Sources: Contract to Provide Services (Amerigroup Corp), Contract to Provide Services (Centene Corp)
Utilization Data. The contractor shall conduct a quarterly analysis of utilization data, including inpatient utilization, and shall follow-up on cases of potential under- under-and over-utilization. Over- Over-and under-utilization shall be determined based on comparison to established medical community standards. See Section A.7.7 A. 7.7 of the Appendices (Table 5) for a description of utilization data to be submitted to the Department.
Appears in 1 contract