Participating Provider Practice Guidelines, General Standards Clause Samples
The "Participating Provider Practice Guidelines, General Standards" clause establishes the baseline expectations and requirements that healthcare providers must follow when participating in a network or program. It typically outlines standards for clinical practice, patient care, record-keeping, and compliance with applicable laws and regulations. For example, providers may be required to adhere to evidence-based treatment protocols and maintain certain licensure or accreditation. The core function of this clause is to ensure consistent, high-quality care across all participating providers and to protect patients and the network from substandard practices.
Participating Provider Practice Guidelines, General Standards. (A) The Contractor and its Participating Providers shall develop or adopt practice guidelines consistent with current standards of care. The practice guidelines shall meet the following requirements:
(1) Guidelines shall be based on valid and reliable clinical evidence or a consensus of health care professionals in the particular field;
(2) Guidelines shall consider the needs of the Contractor’s Health Plan Enrollees;
(3) Guidelines shall be adopted in consultation with contracting health care professionals; and
(4) Guidelines shall be reviewed and updated periodically as appropriate.
(B) The Contractor shall disseminate the practice guidelines to all affected Participating Providers and, upon request, to Enrollees.
(C) The Contractor shall ensure that decisions for utilization management, Enrollee education, coverage of services, and other areas to which the guidelines apply are consistent with the practice guidelines.
Participating Provider Practice Guidelines, General Standards. (A) The Contractor and its Participating Providers shall develop or adopt practice guidelines consistent with current standards of care as recommended by professional groups such as the American Academy of Pediatric Dentistry and the U.S. Preventative Services Task Force. The practice guidelines shall meet the following requirements:
Participating Provider Practice Guidelines, General Standards. (A) The Contractor and its Participating Providers shall develop or adopt practice guidelines consistent with current standards of care as recommended by professional groups such as the American Academy of Pediatric Dentistry and the U.S. Preventative Services Task Force. The practice guidelines shall meet the following requirements:
(1) Guidelines shall be based on valid and reliable clinical evidence or a consensus of dental care professionals in the particular field;
(2) Guidelines shall consider the needs of the Contractor’s Dental Plan Enrollees;
(3) Guidelines shall be adopted in consultation with contracting dental care professionals; and
(4) Guidelines shall be reviewed and updated periodically as appropriate.
(B) The Contractor shall disseminate the practice guidelines to all affected Participating Providers and, upon request, to Enrollees and Potential Enrollees.
(C) The Contractor shall ensure that decisions for utilization management, Enrollee education, coverage of services, and other areas to which the guidelines apply are consistent with the practice guidelines.
Participating Provider Practice Guidelines, General Standards. (A) The Contractor and its Participating Providers shall develop or adopt practice guidelines consistent with current standards of care as recommended by professional groups such as the American Academy of Pediatrics and the U.S. Preventative Services Task Force. The practice guidelines shall meet the following requirements:
(1) Guidelines shall be based on valid and reliable clinical evidence or a consensus of health care professionals in the particular field;
(2) Guidelines shall consider the needs of the Contractor’s Health Plan Enrollees;
(3) Guidelines shall be adopted in consultation with contracting health care professionals; and
(4) Guidelines shall be reviewed and updated periodically as appropriate.
(B) The Contractor shall disseminate the practice guidelines to all affected Participating Providers and, upon request, to Enrollees and Potential Enrollees.
(C) The Contractor shall ensure that decisions for utilization management, Enrollee education,