UM Program definition

UM Program means CalOptima’s Utilization Management Program.
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UM Program means PHCP's utilization management program, which is part of the QI Program, and involves a comprehensive effort to monitor and manage the effective, efficient and timely use of health care services. The UM Program, at a minimum, shall satisfy the utilization management requirements of the Maryland Medicaid Managed Care Program.
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UM Program means either the utilization management program established and administered by KHF or the utilization management program required by a Payer in a Payer Agreement or required by an entity pursuant to an Agreement with KHF.
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Examples of UM Program in a sentence

  • The Contractor shall have a Utilization Management (UM) Program assuring that beneficiaries have appropriate access to SUD services; medical necessity has been established, the beneficiary is at the appropriate ASAM level of care, and that the interventions are appropriate for the diagnosis and level of care.

  • The Medical Director and Behavioral Health Director shall supervise the UM Program and shall be accessible and available for consultation as needed.

  • The Contractor shall implement a Utilization Management (UM) Program that meets the requirements set forth in this section and that is documented in a plan as defined in KRS 304.17A- 600.

  • The Contractor shall have a comprehensive UM Program that reviews services for Medical Necessity and clinical appropriateness, and that monitors and evaluates on an ongoing basis the appropriateness of care and services for physical and behavioral health.

  • Such limitations and authorization requirements shall be included in the UM Program description as set forth in Section 20.0 “Utilization Management”.

  • Standard – 90% of calls answered within thirty (30) seconds Total Quarterly Threshold Liquidated Damages 90.00 % - 100.00% None 85.00% - 89.99% 2.0% of Quarterly Core UM Program Fees Below 85.00% 3.0% of Quarterly Core UM Program Fees Pre-Admission Reviews Standard: 99% of all pre-admission reviews will be completed within two (2) business days of initial call to UM Vendor measured quarterly.

  • Error transactions may include, but are not limited to, missing data in the data file, a failed file transfer, and inability of the Vendor to successfully retrieve the data file, and a data file transmitted to Vendor in a format that deviates from the required file layout Liquidated Damages: 10% of Core UM Program Fees Standard Reports and Report Frequencies Standard: All UM Vendor management reports due to the Board will be submitted within fifteen (15) calendar days from the end of the reporting cycle.

  • Liquidated Damages: 2% of Quarterly Core UM Program Fees Data Transfer Standard: 99% of error transactions from the data transfer sent to the Plan’s Vendors will be corrected and returned to the Vendors via data transfer within two (2) business days of receipt of the error report.

  • BCBSTX shall conduct peer review, quality improvement and the UM Program in accordance with Applicable Laws.

  • Liquidated Damages: 5% of Core UM Program Fees Tobacco Cessation Program – (Optional Service) Standard: For those participants enrolled in the Tobacco Cessation program, the quit rate after six (6) months will be 15% or greater.

Related to UM Program

  • (3) PROGRAM.—The term program’ means

  • Development Program means the implementation of the development plan.

  • Pilot program means the pilot program identified and funded through the Funding Agreement and described in that Funding Agreement and its attachments.

  • Development Plan has the meaning set forth in Section 3.2.

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • Marketing Plan means a plan or system concerning a material aspect of conducting business. Indicia of a marketing plan include any of the following:

  • Program means the statutorily authorized activities of the System Agency under which this Contract has been awarded.

  • Apprenticeship program means a program registered with the U.S. Bureau of Apprenticeship and Training which contains the terms and conditions for the qualification, recruitment, selection, employment and training of apprentices, including the requirement for a written apprenticeship agreement.

  • Educational program means a program for educating and preparing physician assistants which is approved by the board.

  • Training program means an NCA-approved Iowa college, the Iowa law enforcement academy or an Iowa hospital approved by the department to conduct emergency medical care training.

  • Dependent care assistance program means a benefit plan