Utilization Review Compliance Sample Clauses

Utilization Review Compliance. (a) Participating Provider agrees to participate in and comply with the utilization review program adopted by the WPPA, to comply with its policies, rules, regulations and to participate in any grievance procedure established by the WPPA to resolve Participating Patient grievances. The WPPA's Utilization Review and Quality Assessment Program for preadmission, concurrent and retrospective utilization review follows the concepts of the Medical Society Medical Review Foundation program, utilizing the Interqual ISDA Guidelines, and is incorporated herein by reference. The program shall be available for review by Participating Physicians and Group at the places and times stated in Paragraph 5.3. The WPPA will notify Provider of its policies, rules, regulations and amendments to the review program not less than fifteen (15) days prior to the effective date thereof. (b) The Participating Provider acknowledges, in all events, that the Provider has an independent responsibility to provide good medical care to Participating Patients and that any action taken by the WPPA or Group pursuant to WPPA's utilization review program in no way absolves Provider from the responsibility to provide appropriate medical care to Participating Patients. Nothing in this agreement shall be in any manner with the methods or means by which a Participating Physician renders services to Participating Patients.
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Utilization Review Compliance. (a) Participating Hospital agrees to participate in and comply with the utilization review program adopted by the WPPA, to comply with its policies, rules, regulations and to participate in any grievance procedure established by the WPPA to resolve Participating Patient grievances. The WPPA's Utilization Review and Quality Assessment Program for preadmission, concurrent and retrospective utilization review follows the concepts of the Medical Society Medical Review Foundation program, utilizing modified Interqual ISDA Guidelines, and is incorporated herein by reference. The program shall be available for review by Participating Hospital and Group at the places and times stated in Paragraph 5.3. The WPPA will notify the Participating Hospital of its policies, rules, regulations, and amendments to the review program not less than fifteen (15) days prior to the effective date thereof. (b) The Participating Hospital acknowledges, in all events, that it has an independent responsibility to provide good hospital care to Participating Patients. Nothing in this Agreement shall be construed to create any right of the WPPA to intervene in any manner with the methods or means by which a Participating Hospital renders services to Participating Patients.
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Related to Utilization Review Compliance

  • Utilization Review NOTE: The Utilization Review process does not apply to Services that are not covered by Blue Shield because of a coverage determination made by Medicare. State law requires that health plans disclose to Sub- scribers and health plan providers the process used to authorize or deny health care services under the plan. Blue Shield has completed documentation of this process ("Utilization Review"), as required un- der Section 1363.5 of the California Health and Safety Code. To request a copy of the document describing this Utilization Review process, call the Customer Service Department at the telephone number indicated on your Identification Card.

  • Program Compliance The School Board shall be responsible for monitoring the program to provide technical assistance and to ensure program compliance.

  • Monitoring Compliance Upon the request of the Lender, but without incurring any liability beyond the Guaranteed Obligations, from time to time, Guarantor shall promptly provide to the Lender such documents, certificates and other information as may be deemed reasonably necessary to enable the Lender to perform its functions under the Servicing Agreement as the same relates to the Guarantor.

  • Compliance Review During the Term, Developer agrees to permit the GLO, HUD, and/or a designated representative of the GLO or HUD to access the Property for the purpose of performing Compliance-Monitoring Procedures. In accordance with GLO Compliance-Monitoring Procedures, the GLO or HUD will periodically monitor and audit Developer’s compliance with the requirements of this Agreement, the CDBG-DR Regulations, the CDBG Multifamily Rental Housing Guidelines, and any and all other Governmental Requirements during the Term. In conducting any compliance reviews, the GLO or HUD will rely primarily on information obtained from Developer’s records and reports, on-site monitoring, and audit reports. The GLO or HUD may also consider other relevant information gained from other sources, including litigation and citizen complaints. 5.04 HAZARDOUS MATERIALS: INDEMNIFICATION

  • CEQA Compliance The District has complied with all assessment requirements imposed upon it by the California Environmental Quality Act (Public Resource Code Section 21000 et seq. (“CEQA”) in connection with the Project, and no further environmental review of the Project is necessary pursuant to CEQA before the construction of the Project may commence.