Credentialing and Re-credentialing. 13.1 Contractor shall ensure that all staff and subcontractors providing services will have all necessary and valid professional certification(s) or license(s) to practice the contracted services. This includes implementing procedures of professional license checks, credentialing and re-credentialing, monitoring limitations and expiration of licenses, and ensuring that all providers have a current National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES). Contractor shall provide evidence of these completed verifications when requested by County, DHCS or the US Department of Health & Human Services.
Credentialing and Re-credentialing. The Contractor shall credential Providers, except as provided in Section 2.8.8.4, in accordance with NCQA credentialing standards as well as applicable HFS, DHS, DoA, Illinois Department of Insurance and federal requirements. Re-credentialing shall occur every three (3) years. At re-credentialing and on a continuing basis, the Contractor shall verify minimum credentialing requirements and monitor Enrollee Complaints and Appeals, quality of care and quality of service events, and medical record review.
Credentialing and Re-credentialing. 20.1 Contractors must follow the uniform process for credentialing and re-credentialing of network providers established by the MHP and pursuant to 42 C.F.R. § 438.214. The Contractor, at minimum, must verify and document specified items listed on the credentialing and re-credentialing procedure for all of its providers through a primary source and must verify and document all the specified items on the credentialing and re-credentialing procedure through a non-primary source.
Credentialing and Re-credentialing. Provider agrees to meet the credentialing and re- credentialing criteria, standards, and policies established by BCBSM, as may be amended from time to time. Provider shall comply with all credentialing and re-credentialing requirements set forth by CMS. These standards include maintenance of acceptable levels of any required liability insurance. BCBSM retains sole discretion to determine whether Provider shall be accepted as a Participating Provider pursuant to BCBSM’s policies, rules, procedures, and contracting and credentialing standards. To the extent BCBSM delegates the selection of providers to Provider, BCBSM retains the right to approve, suspend, or terminate such arrangement.
Credentialing and Re-credentialing. Provider agrees to meet the credentialing and re- credentialing criteria, standards, and policies established by BCBSM, as may be amended from time to time. Provider shall comply with all credentialing and re-credentialing requirements set forth by CMS. These standards include maintenance of acceptable levels of any required liability insurance. BCBSM retains sole discretion to determine whether Provider shall be accepted as a Participating Provider pursuant to BCBSM’s policies, rules, procedures, and contracting and credentialing standards.
Credentialing and Re-credentialing. A. Transportation Provider agrees to develop and maintain a Driver Orientation and Training Program. All training and orientation documentation must be maintained by the Transportation Provider in the individual Driver’s file.
Credentialing and Re-credentialing. Provider agrees to comply with One Call’s credentialing and re-credentialing policies and procedures. Provider represents and warrants that information provided to One Call in connection with its Credentialing Application to be a Provider in connection with this Agreement (which is fully incorporated into and made a part of this Agreement) is true and correct in all material respects. Provider shall notify One Call immediately of any material change to any item or information previously provided to One Call. Provider agrees that any such information, which is subsequently found to be false, could result in sanctions including, but not limited to, termination of this Agreement. Provider agrees that One Call may share information related to credentialing and re-credentialing as One Call deems necessary. Provider agrees to comply with One Call and/or Payor’s policies and requirements regarding quality assurance, utilization review, grievances, referrals of Covered Individuals, and maintenance of records.
Credentialing and Re-credentialing. Provider shall cooperate with the credentialing and re-credentialing requirements set forth in the Rules and Standards and as otherwise required by a Payer. Provider’s failure or refusal to participate in and cooperate with the credentialing and re-credentialing processes will result in termination of this Agreement. Provider hereby authorizes WVP to obtain any utilization review, peer review, or other information regarding Provider’s practice of medicine or professional qualifications from any reasonable source, but only if such information is not privileged or confidential under Oregon law, including ORS 41.675, as may be amended from time to time. Provider hereby releases from liability, to the greatest extent permitted by Applicable Law, WVP and each of its members, directors, officers, employees, and agents, and any health care provider or other person or entity who or which furnishes information to WVP in good faith for the purposes described herein.
Credentialing and Re-credentialing. Vendor shall comply with the performance metrics and reporting requirements related to credentialing and re-credentialing as specified below. Monthly reporting shall be provided by the fifteenth (15th) day of the following month.
Credentialing and Re-credentialing
