Medical Management Program definition

Medical Management Program means a Physician-directed program whose goal is to work with Providers and Covered Persons to achieve efficient and appropriate utilization of health care resources.
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Medical Management Program means a program consisting of but not limited to authorization; concurrent medical review; primary case management; and a quality assurance program, with the objective to assure that health care services provided to Participants are medically necessary and delivered in an appropriate setting.
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Examples of Medical Management Program in a sentence

  • Crescent shall contractually require any entity which now or hereafter conducts Medical Management Program on behalf of Crescent pursuant to this Agreement to obtain Crescent’s prior written consent before modifying any Medical Management Program.

  • For purposes of this Section, a “Clean Claim” is a claim for Covered Services submitted by Medical Group which is complete and includes all the information reasonably required by PacifiCare, and as to which request for payment there is no material issue regarding PacifiCare’s obligation to pay under the terms of a Managed Care Plan or PacifiCare’s Medical Management Program.

  • Crescent shall contractually require any entity which now or hereafter conducts Medical Management Program on behalf of Crescent pursuant to this Agreement to obtain Crescent's prior written consent before modifying any Medical Management Program.

  • Upon agreement by Crescent to any modification of, or new implementation of, a Medical Management Program which materially affects Provider, Crescent shall provide written notice to Provider describing such modification or containing a copy of such revised or new Medical Management Program and setting forth a date by which Provider must comply with such modifications, allowing a reasonable amount of time (not less than thirty (30) days) for Provider to comply with such revisions.

  • Upon agreement by Crescent to any modification of, or new implementation of, a Medical Management Program which materially affects Facility, Crescent shall provide written notice to Facility describing such modification or containing a copy of such revised or new Medical Management Program and setting forth a date by which Facility must comply with such modifications, allowing a reasonable amount of time (not less than thirty (30) days) for Facility to comply with such revisions.

  • Covered Services are those medically necessary health care services, supplies and benefits which are required by a Member as determined by Medical Group, PacifiCare or pursuant to an independent third party review in accordance with the Member’s Managed Care Plan and PacifiCare’s Quality Improvement Program and Medical Management Program.

  • In the event of such termination, and upon Plan's reasonable request taking into account the access and service needs of Members, BJC shall replace the terminated BJC Provider with a BJC Provider that meets the credentialing criteria specified in this Agreement and all of the Plan's Medical Management Program and Credentialing Plan requirements as soon as reasonably possible.

  • In rendering services to Beneficiaries of this Product, Physician will comply with the PHO’s Medical Management Program for this Product ("the UM Program") as set forth in the Physician Manual.

  • Furthermore, Medical Group agrees to comply with any updates to PacifiCare’s Medical Management Program concerning the administration and provision of Covered Services to Members that may become legislated as PacifiCare risk only.

  • Outside Empire’s network area, you must obtain precertification from Empire’s Medical Management Program for services from in-network BlueCard® PPO providers (with the exception of MRI, MRA, PET, CAT and Nuclear Cardiology services, which do not require precertification for services rendered from in-network BlueCard® PPO providers outside of Empire’s network area).

Related to Medical Management Program

  • Drug therapy management means the review of a drug therapy regimen of a patient by one or more pharmacists for the purpose of evaluating and rendering advice to one or more practitioners regarding adjustment of the regimen.

  • Medical management technique means a practice which is used to control the cost or utilization of health care services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

  • Project Management Plan means the portion of the Project Development Plan providing the information requested in Section 4.2 of Exhibit B to the ITP.

  • Nutrient management plan means a plan developed or approved by the Department of Conservation and Recreation that requires proper storage, treatment and management of poultry waste, including dry litter, and limits accumulation of excess nutrients in soils and leaching or discharge of nutrients into state waters.

  • Medical cannabis pharmacy means the same as that term is defined in Section 26-61a-102.