Risk Stratification Sample Clauses

Risk Stratification. 2.6.1.1. The STAR+PLUS MMP will develop and implement a risk stratification process that uses a combination of predictive- modeling software, assessment tools, referrals, administrative Claims data, and other sources of information as appropriate that will consider Enrollees’ physical and behavioral health, substance use, and LTSS needs.
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Risk Stratification. Contractor will use an approved health risk stratification mechanism or algorithm to identify new Enrollees with high risk and more complex health care needs. The health risk stratification shall be conducted in accordance applicable DPL(s) as indicated in Section 2.1.5
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Risk Stratification. The act or process of dividing Tenncare members into different levels of need based on their health risk. For TennCare’s Population Health program, risk stratification is accomplished by predictive modeling which is based on claims, pharmacy, lab and other data. Information from health risk assessments is also used to identify member’s risk level. Through this process members are identified for one of three health risk stratification levels. Level Zero is wellness, Level One is low to moderate health risk, and Level Two is the top three percent or the sickest of the sick.
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Risk Stratification. The Contractor shall implement a risk stratification process that meets the requirements of this Section.
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Risk Stratification. An informed estimate of the probability of a person succumbing to a disease or benefiting from a treatment for that disease RWT – The Royal Wolverhampton NHS Trust Rapid Response (RR) - S Service user - Person(s) is receipt of service/ care from agencies involved in data sharing SUS data – Statement of compliance (SoC) – Secondary Purposes - T U V W X Y Z Appendix C – Consent forms and fair processing posters Do we need anything here as we have referred to each organisations’ Privacy Notice/Policy? Do we need something BCF specific – or something more wide reaching for Integration in general to cover ICS etc. Appendix E – List of users for Fibonacci Local authority user access approved for the following roles: Role IG Training received and current? Y/N Date approval given Purpose for requiring access Advanced Social Work Practitioners To enable participation in MDT and to provide joint planning and care Community Care Assessors To enable participation in MDT and to provide joint planning and care Social Workers To enable participation in MDT and to provide joint planning and care Social Care Workers To enable participation in MDT and to provide joint planning and care Admin To enable participation in MDT The Royal Wolverhampton NHS Trust user access approved for the following roles: Role IG Training received and current? Y/N Date approval given Purpose for requiring access Community Matrons To enable participation in MDT and to provide joint planning and care District Nurses/Staff Nurses To enable participation in MDT and to provide joint planning and care Admin To enable participation in MDT Clinical Nurse Specialists To enable participation in MDT and to provide joint planning and care Advanced Nurse Practitioners To enable participation in MDT and to provide joint planning and care Heads of Service To enable participation in MDT and to provide joint planning and care Consultant Geriatrician To enable participation in MDT and to provide joint planning and care Other roles given approval: Role IG Training received and current? Y/N Date approval given Purpose for requiring access Appendix F – List of Roles to be co-located into Integrated Community Neighbourhood Teams Role Description Organisation Senior Social Work Unit Manager CWC Social Work Unit Manager CWC Social Worker CWC CMHT - Social Worker CWC Community Care Assessor/CHC Assessor CWC Social Care Worker CWC Office Manager CWC Service Lead/LNM RWT District Nurses RWT Health Care Assistants RWT Comm...
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Risk Stratification. 1.8.1 In the event DCFS is not in agreement with the risk level determination made by Contractor for a DCFS Youth in Care Enrollee, Contractor will work collaboratively with the Department and DCFS to resolve the disagreement and ensure that the best interest and needs of the DCFS Youth in Care Enrollee are met.
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Related to Risk Stratification

  • DEVELOPMENT OR ASSISTANCE IN DEVELOPMENT OF SPECIFICATIONS REQUIREMENTS/ STATEMENTS OF WORK Firms and/or individuals that assisted in the development or drafting of the specifications, requirements, statements of work, or solicitation documents contained herein are excluded from competing for this solicitation. This shall not be applicable to firms and/or individuals providing responses to a publicly posted Request for Information (RFI) associated with a solicitation.

  • How to Obtain Prescription Drug Preauthorization To obtain prescription drug preauthorization, the prescribing provider must submit a prescription drug preauthorization request form. These forms are available on our website or by calling the number listed for the “Pharmacist” on the back of your ID card. Prescription drugs that require preauthorization will only be approved when our clinical guidelines are met. These guidelines are based upon clinically appropriate criteria that ensure that the prescription drug is appropriate and cost- effective for the illness, injury or condition for which it has been prescribed. We will send you written notification of the prescription drug preauthorization determination within fourteen (14) calendar days of the receipt of the request. How to Request an Expedited Preauthorization Review You may request an expedited review if the circumstances are an emergency. Due to the urgent nature of an expedited review, your prescribing provider must either call or fax the completed form and indicate the urgent nature of the request. When an expedited preauthorization review is received, we will respond to you with a determination within seventy-two (72) hours or less. If we deny your request for preauthorization, you can submit a medical appeal. See Appeals in Section 5 for information on how to file a medical appeal. Formulary Exception Process When a prescription drug is not on our formulary, you can request that this plan cover the drug as an exception. To request a formulary exception, complete a Coverage Exception form (located on our website), contact our Customer Service Department, or have your prescribing provider submit a request for you. We will respond to you with a determination within seventy- two (72) hours following receipt of the request. For standard exception reviews, if the exception is approved, we will cover the prescription drug for the duration of the prescription, including refills. How to Request an Expedited Formulary Exception Review You may request an expedited review if a delay could significantly increase the risk to your health or your ability to regain maximum function, or you are undergoing a current course of treatment with a drug not on our formulary. Please indicate “urgent” on the Coverage Exception form or inform Customer Service of the urgent nature of your request. We will respond to you with a determination within twenty-four (24) hours following receipt of the request. For expedited exception reviews, if the exception is approved, we will cover the prescription drug for the duration of the exigency. For both standard and expedited exception reviews, if we grant your request for a formulary exception, the amount you pay will be the copayment at the highest formulary tier in your plan. Other applicable benefit requirements, such as step therapy, are not waived by this exception and must be reviewed separately. If we deny your request for a formulary exception, we will notify you with information on how to appeal our decision, including external appeal information.

  • CENTRAL GRIEVANCE PROCESS The following process pertains exclusively to grievances on central matters that have been referred to the central process. In accordance with the School Boards Collective Bargaining Act central matters may also be grieved locally, in which case local grievance processes will apply.

  • REGULATORY FILINGS AND CAISO TARIFF COMPLIANCE 3.1 Filing

  • Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time.

  • CONTRACTOR NAME CHANGE An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment.

  • CONTRACTOR STAFF WITHIN AUTHORIZED USER AGREEMENT The provisions of this section shall apply unless otherwise agreed in the Authorized User Agreement. All employees of the Contractor, or of its Subcontractors, who shall perform under an Authorized User Agreement, shall possess the necessary qualifications, training, licenses, and permits as may be required within the jurisdiction where the Services specified are to be provided or performed, and shall be legally entitled to work in such jurisdiction. All Business Entities that perform Services under the Contract on behalf of Contractor shall, in performing the Services, comply with all applicable Federal, State, and local laws concerning employment in the United States. Staffing Changes within Authorized User Agreement

  • Medical Examinations An employee may be required by the Employer, at the request of and at the expense of the Employer, to take a medical examination by a physician of the employee's choice. Employees may be required to take skin tests, x-ray examination, vaccination, inoculation and other immunization (with the exception of a rubella vaccination when the employee is of the opinion that a pregnancy is possible), unless the employee's physician has advised in writing that such a procedure may have an adverse affect on the employee's health.

  • Tuberculosis Examination The examination shall consist of an approved intradermal tuberculosis test, which, if positive, shall be followed by an X-ray of the lungs. Nothing in Sections 5163 to 5163.2, inclusive, shall prevent the governing body of any city or county, upon recommendation of the local health officer, from establishing a rule requiring a more extensive or more frequent examination than required by Section 5163 and this section. § 5163.2. Technician taking X-ray film; Interpretation of X-ray The X-ray film may be taken by a competent and qualified X-ray technician if the X-ray film is subsequently interpreted by a licensed physician and surgeon.

  • CERTIFICATION REGARDING CERTAIN FOREIGN-OWNED COMPANIES IN CONNECTION WITH CRITICAL INFRASTRUCTURE (Texas law as of September 1, 2021) By submitting a proposal to this Solicitation, you certify that you agree to the following required by Texas law as of September 1, 2021: Proposing Company is prohibited from entering into a contract or other agreement relating to critical infrastructure that would grant to the company direct or remote access to or control of critical infrastructure in this state, excluding access specifically allowed by the Proposing Company for product warranty and support purposes. Company, certifies that neither it nor its parent company nor any affiliate of company or its parent company, is (1) owned by or the majority of stock or other ownership interest of the company is held or controlled by individuals who are citizens of China, Iran, North Korea, Russia, or a designated country; (2) a company or other entity, including governmental entity, that is owned or controlled by citizens of or is directly controlled by the government of China, Iran, North Korea, Russia, or a designated country; or (3) headquartered in China, Iran, North Korea, Russia, or a designated country. For purposes of this contract, “critical infrastructure” means “a communication infrastructure system, cybersecurity system, electric grid, hazardous waste treatment system, or water treatment facility.” See Tex. Gov’t Code § 2274.0101(2) of SB 1226 (87th leg.). The company verifies and certifies that company will not grant direct or remote access to or control of critical infrastructure, except for product warranty and support purposes, to prohibited individuals, companies, or entities, including governmental entities, owned, controlled, or headquartered in China, Iran, North Korea, Russia, or a designated country, as determined by the Governor.

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