Common use of Utilization Review Clause in Contracts

Utilization Review. 13 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 to review and evaluate a random selection of PARTICIPANT case records. The 16 review shall include, but is not limited to, an evaluation of the necessity 17 and appropriateness of services provided and length of services. PARTICIPANT 18 cases to be reviewed shall be randomly selected by ADMINISTRATOR.

Utilization Review. 13 8.1 2 10.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 3 request at CONTRACTOR’s facility identified in Paragraph 6 7 of this Exhibit A, 15 A 4 to review and evaluate a random selection of PARTICIPANT case records. The 16 5 review shall include, but is not limited to, an evaluation of the necessity 17 and appropriateness of services provided necessity, 6 appropriateness, and length of servicesservices provided. PARTICIPANT 18 cases to be 7 reviewed shall be randomly selected by ADMINISTRATORCOUNTY.

Utilization Review. 13 11 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 12 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 13 to review and evaluate a random selection of PARTICIPANT case records. The 16 14 review shall include, but is not limited to, an evaluation of the necessity 17 15 and appropriateness of services provided and length of services. PARTICIPANT 18 16 cases to be reviewed shall be randomly selected by ADMINISTRATOR.

Utilization Review. 13 23 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 24 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 25 to review and evaluate a random selection of PARTICIPANT case records. The 16 26 review shall include, but is not limited to, an evaluation of the necessity 17 27 and appropriateness of services provided and length of services. PARTICIPANT 18 28 cases to be reviewed shall be randomly selected by ADMINISTRATOR.

Utilization Review. 13 8.1 10.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 request at CONTRACTOR’s facility identified in Paragraph 6 7 of this Exhibit A, A 15 to review and evaluate a random selection of PARTICIPANT case records. The 16 review shall include, but is not limited to, : an evaluation of the necessity necessity, 17 and appropriateness of services provided appropriateness, and length of servicesservices provided. PARTICIPANT 18 cases to be 18 reviewed shall be randomly selected by ADMINISTRATORCOUNTY.

Utilization Review. 13 8.1 15 10.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 16 request at CONTRACTOR’s facility identified in Paragraph 6 7 of this Exhibit A, 15 A 17 to review and evaluate a random selection of PARTICIPANT case records. The 16 18 review shall include, but is not limited to, an evaluation of the necessity 17 and appropriateness of services provided necessity, 19 appropriateness, and length of servicesservices provided. PARTICIPANT 18 cases to be 20 reviewed shall be randomly selected by ADMINISTRATORCOUNTY.

Utilization Review. 13 24 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATORADMINSTRATOR’s 14 25 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 26 to review and evaluate a random selection of PARTICIPANT case records. The 16 27 review shall include, but is not limited to, an evaluation of the necessity 17 28 and appropriateness of services provided and length of services. PARTICIPANT 18 1 cases to be reviewed shall be randomly selected by ADMINISTRATOR.

Utilization Review. 13 8.1 15 10.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 16 request at CONTRACTOR’s facility identified in Paragraph 6 7 of this Exhibit A, 15 A 17 to review and evaluate a random selection of PARTICIPANT case records. The 16 18 review shall include, but is not limited to, : an evaluation of the necessity 17 and appropriateness of services provided necessity, 19 appropriateness, and length of servicesservices provided. PARTICIPANT 18 cases to be 20 reviewed shall be randomly selected by ADMINISTRATORCOUNTY.

Utilization Review. 13 2 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 3 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 to review and evaluate a random selection of PARTICIPANT case records. The 16 5 review shall include, but is not limited to, an evaluation of the necessity 17 6 and appropriateness of services provided and length of services. PARTICIPANT 18 7 cases to be reviewed shall be randomly selected by ADMINISTRATOR.

Utilization Review. 13 8.1 18 10.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 19 request at CONTRACTOR’s facility identified in Paragraph 6 7 of this Exhibit A, 15 A 20 to review and evaluate a random selection of PARTICIPANT case records. The 16 21 review shall include, but is not limited to, an evaluation of the necessity 17 and appropriateness of services provided necessity, 22 appropriateness, and length of servicesservices provided. PARTICIPANT 18 cases to be 23 reviewed shall be randomly selected by ADMINISTRATORCOUNTY.

Utilization Review. 13 8.1 6 10.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATOR’s 14 7 request at CONTRACTOR’s facility identified in Paragraph 6 7 of this Exhibit A, 15 A 8 to review and evaluate a random selection of PARTICIPANT case records. The 16 9 review shall include, but is not limited to, : an evaluation of the necessity 17 and appropriateness of services provided necessity, 10 appropriateness, and length of servicesservices provided. PARTICIPANT 18 cases to be 11 reviewed shall be randomly selected by ADMINISTRATORCOUNTY.

Utilization Review. 13 22 8.1 CONTRACTOR and ADMINISTRATOR shall meet upon ADMINISTRATORADMINSTRATOR’s 14 23 request at CONTRACTOR’s facility identified in Paragraph 6 of this Exhibit A, 15 24 to review and evaluate a random selection of PARTICIPANT case records. The 16 25 review shall include, but is not limited to, an evaluation of the necessity 17 26 and appropriateness of services provided and length of services. PARTICIPANT 18 27 cases to be reviewed shall be randomly selected by ADMINISTRATOR.