1. Agreement and Collaboration with Health Plans (PO 1)
- Has the organization worked with the client to develop a mutually agreed-upon document that describes each party’s responsibilities, delegated activities, frequency of reporting to client, process by which the client evaluates the organization and the remedies available to the client if the client does not fulfill its obligations?
- Has the organization provided the client with documents necessary to conduct oversight and provided the client with reports at agreed-upon frequency?
- Has the organization cooperated with the client’s efforts to implement quality improvement and other activities?
- Has the organization given the client access to its medical records?
2. Confidentiality Policies (PO 2)
- Has the organization implemented confidentiality policies and procedures to maintain confidentiality of information for any purpose and protect medical records?
- Has the organization developed policies to obtain members’ permission before releasing confidential information, do the organization’s practitioner contracts address confidentiality of member information and records?