Credentialing Process Clause Samples
The Credentialing Process clause outlines the procedures and requirements for verifying the qualifications and background of individuals or entities before they are permitted to perform certain roles or services. Typically, this involves submitting documentation such as licenses, certifications, and references, and may include background checks or interviews. By establishing a standardized process for credential verification, this clause ensures that only qualified and vetted parties are engaged, thereby reducing risk and maintaining quality standards.
Credentialing Process. The full Credentialing process is governed by DCF Policy 31-12-12.3 which can be found under "Policy and Regulations" on the Department website: ▇▇▇▇://▇▇▇.▇▇.▇▇▇/dcf.
Credentialing Process. County’s subcontracted Providers shall be credentialed and recredentialed through CalOptima’s credentialing process. Notwithstanding County’s subcontracted Providers’ representations in any pre-application questionnaire, in this Contract and/or in connection with any Health Network credentialing application, CalOptima reserves the right to verify any and all Minimum Standards and any other credentialing standards CalOptima, in its sole judgment, deems necessary and appropriate to County’s subcontracted Providers’ eligibility to participate in CalOptima’s Programs. County’s subcontracted Providers’ participation in CalOptima’s Programs is subject to CalOptima’s approval of County’s subcontracted Providers’ credentialing application. The procedure and criteria for review of County’s subcontracted Providers’ credentials and initial and continued eligibility shall be established by CalOptima, and may be amended from time to time. This Contract may be terminated by CalOptima at any time a significant portion of County’s subcontracted Providers fail to meet the standards for continued eligibility to participate in CalOptima’s Programs.
Credentialing Process. Provider Enrollment Coversheet
Credentialing Process. County's subcontracted Providers shall be credentialed and recredentialed through CalOptima's credentialing process. Notwithstanding County's subcontracted Providers' representations in any pre-application questionnaire, in this Contract and/or in connection with any Health Network credentialing application, CalOptima reserves the right to verify any and all Minimum Standards and any other credentialing standards CalOptima, in its sole Orange County Health Care Agency- Public Health Coordination and Provision of Public Health Care Services Contract _Medi-Cal June I, 2013 judgment, deems necessary and appropriate to County's subcontracted Providers' eligibility to participate in CalOptima's Programs. County's subcontracted Providers' participation in CalOptima's Programs is subject to CalOptima's approval of County's subcontracted Providers' credentialing application. The procedure and criteria for review of County's subcontracted Providers' credentials and initial and continued eligibility shall be established by CalOptima, and may be amended from time to time. This Contract may be terminated by CalOptima at any time a significant portion of County's subcontracted Providers fail to meet the standards for continued eligibility to participate in CalOptima's Programs.
Credentialing Process a. Contractor shall have written policies and procedures for credentialing and recredentialing Providers, which includes collecting evidence of credentials and screening the credentials of Providers, programs and facilities used to deliver Covered Services. These policies and procedures shall be consistent with OAR 410-141-0120, Oregon Health Plan Prepaid Health Plan Provision of Health Care Services and shall include verifying possession of valid licenses or certificates if any are required under any federal, state, or local law, rule, or regulation to deliver Covered Services in the State of Oregon. These policies and procedures shall also include collecting proof of liability.
b. Contractor shall submit all changes to its current credentialing and recredentialing policy and procedure to DHS for review and approval, as of the effective date of this Contract. If there are no changes to the Contractor’s current credentialing and recredentialing policies and procedures Contractor shall submit Schedules 5.0 and 5.1 as of the effective date of this Contract.
(1) If Participating Providers are not required to be licensed or certified by a State of Oregon board or licensing agency, then:
(a) Participating Providers must meet the definitions for QMHA or QMHP as described in Exhibit A, Definitions and Provide Services under the supervision of a LMP as defined in Exhibit A, Definitions; or
(b) For Participating Providers not meeting either the QMHP or QMHA definition, Contractor shall document and certify that the person’s education, experience, competence, and supervision are adequate to permit the person to perform his or her specific assigned duties.
(2) All programs operated directly or by subcontract must be accredited by nationally recognized organizations (e.g., Council on Accredited Rehabilitation Facilities (CARF), TJC and/or are certified under OAR 309-012-0130 et. seq. or licensed under ORS Chapter 443 by the State of Oregon to deliver specified Services (e.g. OAR 309- 032-0175 through 309-032-1565, Standards for Adult Mental Health Services; OAR
(3) Facilities used to deliver services specified in OAR 309-032-0175 through 309-032- 1565, Standards for Regional Acute Care Psychiatric Services for Adults, OAR 309- 033-0700 through 309-033-0740, Standards for the Approval of Community Hospital and Non-hospital Facilities to Provide Seclusion and Restraint to Committed Persons in Custody or on Diversion and OAR 309-032-1100 through 309-032-1230 must be cert...
Credentialing Process. The Contractor shall implement written policies and procedures that comply with the EOHHS requirements set forth below regarding the selection, retention, and exclusion of Providers from the Provider Network. Such written policies and procedures shall, at a minimum:
Credentialing Process