Medical Management Programs definition

Medical Management Programs means the reasonable customer satisfaction plans, quality management programs, utilization management programs, credentialing, rules and regulations, provider sanctions, grievance procedures, and other similar programs, procedures and protocols conducted by or on behalf of Payors and/or Crescent pursuant to this Agreement, the applicable Crescent Network Access Agreement and Crescent’s participating provider agreements with other Crescent Providers.
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Medical Management Programs shall have the meaning set forth in Section 8.4.
Sample 1

Examples of Medical Management Programs in a sentence

  • Provider agrees to participate in Medical Management Programs related to Provider Services and related amendments, if any, which are provided to Provider regarding Provider Services to Members.

  • Provider understands that Crescent or Payor (or their designee) may in accordance with Medical Management Programs develop, adopt and implement reasonable standards (“Performance Standards”) related to the need for, and efficiency and quality of, Provider Services.

  • Crescent may gather outcomes and performance data regarding Provider Services rendered by Provider and other Crescent Providers in accordance with Medical Management Programs.

  • Crescent will maintain copies of all Medical Management Programs conducted by Crescent or Crescent’s designee and make such copies available for inspection and copying by Provider during normal business hours.

  • All Medical Management Programs now or hereafter conducted directly by Crescent pursuant to this Agreement shall be conducted in a manner substantially consistent with all applicable Joint Commission and NCQA requirements, the requirements of the Healthcare Quality Improvement Act of 1986, as amended, and all other regulatory standards and criteria for such programs.

  • Pursuant to participation in Crescent’s or Payor’s Medical Management Programs, Provider will cooperate with Crescent’s, a Payor’s or a TPA’s sanction processes and will cooperate with Members in any applicable grievance processes for Members.

  • Provider understands that Crescent may charge Payors a fee for the use of the Crescent provider network, and Crescent shall charge Payors a fee for any Medical Management Programs or other administrative services provided.

  • Pursuant to participation in Crescent’s or Payor’s Medical Management Programs, Provider agrees to cooperate with and participate in reasonable utilization management and quality assessment programs developed by Crescent, or by a Payor or TPA for related Plan(s), and understands that failure to comply with applicable utilization requirements may result in reductions of payment to Provider, depending on the applicable program or Plan.

  • Crescent or its designee may permit Payors and their designees to conduct Medical Management Programs and shall contractually require such entities to meet such legal and regulatory requirements.

  • An outline of applicable sanction and grievance processes will be distributed to Provider by Crescent, TPA or Payor, as appropriate, and a copy of relevant grievance and sanctions provisions of applicable Medical Management Programs will be provided to Provider upon request.

Related to Medical Management Programs

  • Emergency medical services or “EMS” means an integrated medical care delivery system to provide emergency and nonemergency medical care at the scene or during out-of-hospital patient transportation in an ambulance.

  • Medical personnel means those persons assigned, by a Party to the conflict, exclusively to the medical purposes enumerated under subparagraph (e) or to the administration of medical units or to the operation or administration of medical transports. Such assignments may be either permanent or temporary. The term includes: