Utilization Management and Quality Assurance Programs Sample Clauses

Utilization Management and Quality Assurance Programs. Pursuant to participation in Crescent’s or Payor’s Medical Management Programs, Facility 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 Facility, depending on the applicable program or Plan. Crescent shall, and shall contractually require Payor to, define a reasonable process by which Facility can appeal any reduction(s) in payment made pursuant to Crescent’s or Payor’s Medical Management or utilization management programs.
Sample 1Sample 2See All (4)
AutoNDA by SimpleDocs
Utilization Management and Quality Assurance Programs. Provider agrees to comply, cooperate with, and abide by utilization management and quality assurance procedures and protocols as structured and approved by Soteria. Failure to obtain authorizations and/or provide requested documentation shall be cause for denial of payment of the claims. Provider shall not xxxx Beneficiary for services rendered which are denied for payment due to the services being deemed non-medically necessary unless the Beneficiary was informed prior to the services being rendered and agreed in writing to accept Financial responsibility for such services. From time to time, Provider may be asked to serve on a Soteria peer review committee to review documentation pursuant to Soteria cases involving Soteria Providers other than him/herself.
Sample 1

Related to Utilization Management and Quality Assurance Programs

  • COUNTY’S QUALITY ASSURANCE PLAN The County or its agent will evaluate the Contractor’s performance under this Contract on not less than an annual basis. Such evaluation will include assessing the Contractor’s compliance with all Contract terms and conditions and performance standards. Contractor deficiencies which the County determines are severe or continuing and that may place performance of the Contract in jeopardy if not corrected will be reported to the Board of Supervisors. The report will include improvement/corrective action measures taken by the County and the Contractor. If improvement does not occur consistent with the corrective action measures, the County may terminate this Contract or impose other penalties as specified in this Contract.

  • Quality Assurance Program An employee shall be entitled to leave of absence without loss of earnings from her or his regularly scheduled working hours for the purpose of writing examinations required by the College of Nurses of Ontario arising out of the Quality Assurance Program.

  • SMHS Governance, Safety and Quality Requirements 4.1 Participates in the maintenance of a safe work environment.

  • EMHS Governance, Safety and Quality Requirements 4.1 Participates in the maintenance of a safe work environment.

  • NMHS Governance, Safety and Quality Requirements 3.1 Participates in the maintenance of a safe work environment.

  • Quality Assurance Plan The contractor shall develop and submit to NMFS a contractor Quality Assurance Plan, as referenced in Section F.5.3, which details how the contractor will ensure effectiveness and efficiency of collection efforts as well as the quality of data collected by its At-Sea Monitors. The contractor shall further establish, implement, and maintain a Quality Assurance Management program to ensure consistent quality of all work products and services performed under this contract.

  • Quality Assurance/Quality Control Contractor shall establish and maintain a quality assurance/quality control program which shall include procedures for continuous control of all construction and comprehensive inspection and testing of all items of Work, including any Work performed by Subcontractors, so as to ensure complete conformance to the Contract with respect to materials, workmanship, construction, finish, functional performance, and identification. The program established by Contractor shall comply with any quality assurance/quality control requirements incorporated in the Contract.

  • Program Monitoring and Evaluation (c) The Recipient shall prepare, or cause to be prepared, and furnish to the Association not later than six months after the Closing Date, a report of such scope and in such detail as the Association shall reasonably request, on the execution of the Program, the performance by the Recipient and the Association of their respective obligations under the Legal Agreements and the accomplishment of the purposes of the Financing.”

  • Enterprise Information Management Standards Grantee shall conform to HHS standards for data management as described by the policies of the HHS Office of Data, Analytics, and Performance. These include, but are not limited to, standards for documentation and communication of data models, metadata, and other data definition methods that are required by HHS for ongoing data governance, strategic portfolio analysis, interoperability planning, and valuation of HHS System data assets.

  • Monitoring and Review 5.1 The Council and the BID Company shall set up the Standard Services Review Panel within 28 days from the date of this Agreement the purpose of which shall be to:

Time is Money Join Law Insider Premium to draft better contracts faster.