QUALITY IMPROVEMENT, UTILIZATION MANAGEMENT, PERFORMANCE IMPROVEMENT Sample Clauses

QUALITY IMPROVEMENT, UTILIZATION MANAGEMENT, PERFORMANCE IMPROVEMENT. 1. Doctor shall comply with all CCMI and health plan company procedures, including quality improvement, credentialing, medical management, treatment authorization, concurrent monitoring, peer review, utilization management, Enrollee complaint or grievance, remedial measures, and any other similar programs and procedures established by health plan companies and/or CCMI from time to time, including but not limited to the following: A. All treatment plans must be authorized and shall be subject to review by the Credentialing, Quality Improvement, peer review, and remedial measures committees of CCMI. CCMI and health plan companies have the right to verify the clinical accuracy of all submitted information and claims. Doctor shall be responsible for obtaining any authorization required to release medical information to CCMI or a health plan company. Doctor agrees to abide by the decisions of CCMI, including all authorization and review processes of CCMI and health plan companies. Doctor agrees that any act, omission, or decision for which review has not been requested in accordance with procedures established by CCMI, its designees, or health plan companies for review of such act, omission or decision is final. B. Doctor agrees to promptly notify CCMI in writing of all Enrollee or Enrollee related complaints received, and the resolution of the complaint, if any. If a complaint is not resolved by Doctor in a manner satisfactory to the Enrollee or complaining party, CCMI and/or health plan company will follow their procedures to resolve any such complaints. C. Doctor agrees to participate in and cooperate fully with such programs as are established by CCMI and/or health plan companies to assess, evaluate and improve: the ongoing performance of CCMI and its participating doctors related to the provision of health services; the provision of services designed to improve the health of Enrollees, Enrollee satisfaction or administrative efficiency; including without limitation, quality assurance, practice guidelines, health improvement, utilization management, and credentialing programs. Doctor understands and agrees that the credentialing processes of CCMI, its designees, and the health plan companies are audited periodically by health plan companies, CMS, NCQA, and other credentialing bodies on an ongoing basis as required by CMS regulations, and the requirements of the credentialing bodies. Doctor further understands and agrees that s/he must comply with all applic...
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Related to QUALITY IMPROVEMENT, UTILIZATION MANAGEMENT, PERFORMANCE IMPROVEMENT

  • The Performance Improvement Process (a) The Performance Improvement Process will focus on the risks of non- performance and problem-solving. It may include one or more of the following actions: a requirement that the HSP develop and implement an improvement plan that is acceptable to the Funder; the conduct of a Review; an amendment of the HSP’s obligations; an in-year, or year-end, adjustment to the Funding, among other possible means of responding to the Performance Factor or improving performance. (b) Any performance improvement process begun under a prior service accountability agreement that was not completed under the prior agreement will continue under this Agreement. Any performance improvement required by a Funder under a prior service accountability agreement will be deemed to be a requirement of this Agreement until fulfilled or waived by the Funder.

  • Performance Improvement Plan timely and accurate completion of key actions due within the reporting period 100 percent The Supplier will design and develop an improvement plan and agree milestones and deliverables with the Authority 3.2 The Authority may from time to time make changes to the KPIs measured as set out in paragraph 3.1 above and shall issue a replacement version to the Supplier. The Authority shall give notice In Writing of any such change to the KPIs measured and shall specify the date from which the replacement KPIs must be used for future reports. Such date shall be at least thirty (30) calendar days following the date of the notice to the Supplier.

  • Quality Improvement The Parties must develop QI activities specifically for the oversight of the requirements of this MOU, including, without limitation, any applicable performance measures and QI initiatives, including those to prevent duplication of services, as well as reports that track referrals, Member engagement, and service utilization. Such QI activities must include processes to monitor the extent to which Members are able to access mental health services across SMHS and NSMHS, and Covered Service utilization. The Parties must document these QI activities in policies and procedures.

  • CONTRACTOR PERFORMANCE AUDIT The Contractor shall allow the Authorized User to assess Contractor’s performance by providing any materials requested in the Authorized User Agreement (e.g., page load times, response times, uptime, and fail over time). The Authorized User may perform this Contractor performance audit with a third party at its discretion, at the Authorized User’s expense. The Contractor shall perform an independent audit of its Data Centers, at least annually, at Contractor expense. The Contractor will provide a data owner facing audit report upon request by the Authorized User. The Contractor shall identify any confidential, trade secret, or proprietary information in accordance with Appendix B, Section 9(a), Confidential/Trade Secret Materials.

  • STATEWIDE ACHIEVEMENT TESTING When CONTRACTOR is a NPS, per implementation of Senate Bill 484, CONTRACTOR shall administer all Statewide assessments within the California Assessment of Student Performance and Progress (“CAASPP”), Desired Results Developmental Profile (“DRDP”), California Alternative Assessment (“CAA”), achievement and abilities tests (using LEA-authorized assessment instruments), the Fitness Gram, , the English Language Proficiency Assessments for California (“ELPAC”), and as appropriate to the student, and mandated by LEA pursuant to LEA and state and federal guidelines. CONTRACTOR is subject to the alternative accountability system developed pursuant to Education Code section 52052, in the same manner as public schools. Each LEA student placed with CONTRACTOR by the LEA shall be tested by qualified staff of CONTRACTOR in accordance with that accountability program. ▇▇▇ shall provide test administration training to CONTRACTOR’S qualified staff. CONTRACTOR shall attend LEA test training and comply with completion of all coding requirements as required by ▇▇▇.