Common use of Consultation with Provider Clause in Contracts

Consultation with Provider. ▇▇▇▇▇ agrees to consult with PROVIDER regarding ▇▇▇▇▇’ medical policies, quality improvement program and medical management programs to ensure practice guidelines and utilization management guidelines: (a) are based on reasonable medical evidence or a consensus of health care professionals in the particular field; (b) consider the needs of the enrolled population; (c) are developed in consultation with Participating Providers who are physicians; and are reviewed and updated periodically; and (d) are communicated to Participating Providers of the Plan(s) and as appropriate to the Members. With respect to utilization management, Member education, coverage of health care services, and other areas in which guidelines apply, ▇▇▇▇▇ shall ensure decisions are consistent with applicable guidelines.

Consultation with Provider. ▇▇▇▇▇ agrees to consult with PROVIDER regarding ▇▇▇▇▇’ medical policies, quality improvement program and medical management programs to and ensure that practice guidelines and utilization management guidelines: (a) are based on reasonable medical evidence or a consensus of health care professionals in the particular field; (b) consider the needs of the enrolled population; (c) are developed in consultation with Participating Providers who are physicians; and are reviewed and updated periodically; and (d) are communicated to Participating Providers of the Plan(s) Programs and as appropriate to the Members. With respect to utilization management, Member education, coverage of health care services, and other areas in which guidelines apply, ▇▇▇▇▇ shall ensure decisions are consistent with applicable guidelines.

Consultation with Provider. ▇▇▇▇▇ agrees to consult with PROVIDER regarding ▇▇▇▇▇’ medical policies, quality improvement program and medical management programs to and ensure that practice guidelines and utilization management guidelines: (a) are based on reasonable medical evidence or a consensus of health care professionals in the particular field; (b) consider the needs of the enrolled population; (c) are developed in consultation with Participating Providers who are physicians; and are reviewed and updated periodically; and (d) are communicated to Participating Providers of the Plan(s) and as appropriate to the Members. With respect to utilization management, Member education, coverage of health care services, and other areas in which guidelines apply, ▇▇▇▇▇ shall ensure decisions are consistent with applicable guidelines.

Consultation with Provider. ▇▇▇▇▇ agrees to consult with PROVIDER regarding ▇▇▇▇▇’ medical policies, quality improvement program and medical management programs to ensure that practice guidelines and utilization management guidelines: (a) are based on reasonable medical evidence or a consensus of health care professionals in the particular field; (b) consider the needs of the enrolled population; (c) are developed in consultation with Participating Providers who are physicians; and are reviewed and updated periodically; and (d) are communicated to Participating Providers of the Plan(s) Programs and as appropriate to the Members. With respect to utilization management, Member education, coverage of health care services, and other areas in which guidelines apply, ▇▇▇▇▇ shall ensure decisions are consistent with applicable guidelines.

Consultation with Provider. ▇▇▇▇▇ agrees to consult with PROVIDER regarding ▇▇▇▇▇’ medical policies, quality improvement program and medical management programs to ensure that practice guidelines and utilization management guidelines: (a) are based on reasonable medical evidence or a consensus of health care professionals in the particular field; (b) consider the needs of the enrolled population; (c) are developed in consultation with Participating Providers who are physicians; and are reviewed and updated periodically; and (d) are communicated to Participating Providers of the Plan(s) and as appropriate to the Members. With respect to utilization management, Member education, coverage of health care services, and other areas in which guidelines apply, ▇▇▇▇▇ shall ensure decisions are consistent with applicable guidelines.

Consultation with Provider. ▇▇▇▇▇ agrees to consult with PROVIDER regarding ▇▇▇▇▇’ medical policies, quality improvement program and medical management programs and to ensure that practice guidelines and utilization management guidelines: (a) are based on reasonable medical evidence or a consensus of health care professionals in the particular field; (b) consider the needs of the enrolled population; (c) are developed in consultation with Participating Providers who are physicians; and are reviewed and updated periodically; and (d) are communicated to Participating Providers of the Plan(s) and as appropriate to the Members. With respect to utilization management, Member education, coverage of health care services, and other areas in which guidelines apply, ▇▇▇▇▇ shall ensure decisions are consistent with applicable guidelines.

Consultation with Provider. ▇▇▇▇▇ agrees to consult with PROVIDER regarding ▇▇▇▇▇’ medical policies, quality improvement program and medical management programs to and ensure that practice guidelines and utilization management guidelines: (a) are based on reasonable medical evidence or a consensus of health care professionals in the particular field; (b) consider the needs of the enrolled population; (c) are developed in consultation with Participating Providers who are physicians; and are reviewed and updated periodically; and (d) are communicated to Participating Providers of the Plan(s) programs and as appropriate to the Members. With respect to utilization management, Member education, coverage of health care services, and other areas in which guidelines apply, ▇▇▇▇▇ shall ensure decisions are consistent with applicable guidelines.