Provider Credentialing. Contractor shall perform, or may delegate activities related to, credentialing and re-credentialing Participating Providers in accordance with a process reviewed and approved by State Regulators.
Provider Credentialing. The Contractor shall have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re-credentialing process for all contracted providers shall meet the National Committee for Quality Assurance (NCQA) guidelines. The same provider credentialing standards must apply across all Indiana Medicaid programs. The Contractor shall use OMPP’s standard provider credentialing form during the credentialing process. The Contractor must ensure that providers agree to meet all of FSSA’s and the Contractor’s standards for credentialing PMPs and specialists, and maintain IHCP manual standards, including: Compliance with state record keeping requirements; FSSA’s access and availability standards; and Other quality improvement program standards. As provided in 42 CFR 438.214(c), which prevents discrimination in provider selection, the Contractor’s provider credentialing and selection policies shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall not employ or contract with providers that have been excluded from participating in federal health care programs under Section 1128 or Section 1128A of the Social Security Act. The Contractor shall notify OMPP, in the manner prescribed by the State, of any credentialing applications that are denied due to program integrity related reasons. The Contractor shall process all credentialing applications within thirty (30) calendar days of receipt of a complete application. If the Contractor delegates credentialing functions to a delegated credentialing agency, the Contractor shall ensure all credentialed providers are loaded into the Contractor’s provider files and claims system within fifteen (15) calendar days of receipt from the delegated entity. The contractors credentialing and recredentialing process, policies and procedures must be demonstrated in readiness review. The State will implement a centralized model for provider enrollment and credentialing called FSSA EnCred (EnCred) in 2019 consistent with the provisions of IC 12-15-11-9. The State contracts with a certified Credentialing Verification Organization (CVO), which is an accredited credentialing entity, to perform enrollment and credentialing simultaneously for pro...
Provider Credentialing. The CMHSP shall have written credentialing policies and procedures for ensuring that all providers rendering services to individuals are appropriately credentialed within the state and are qualified to perform their services. Credentialing shall take place every two years. The CMHSP must ensure that network providers residing and providing services in bordering states meet all applicable licensing and certification requirements within their state. The CMHSP also must have written policies and procedures for monitoring its providers and for sanctioning providers who are out of compliance with the CMHSPs standards.
Provider Credentialing. The PIHP shall have written credentialing policies and procedures for ensuring that all providers rendering services to individuals are appropriately credentialed within the state and are qualified to perform their services. Credentialing shall take place every two years. The PIHP must ensure that network providers residing and providing services in bordering states meet all applicable licensing and certification requirements within their state. The PIHP also must have written policies and procedures for monitoring its providers and for sanctioning providers who are out of compliance with the PIHP's standards.
Provider Credentialing. The Contractor shall have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re- credentialing process for all contracted providers shall meet the National Committee for Quality Assurance (NCQA) guidelines. The same provider credentialing standards must apply across all Indiana Medicaid programs.
Provider Credentialing. The Contractor’s policies and procedures shall follow the State’s requirements related to the credentialing and re-credentialing of Health Care Professionals who have signed contracts or participation agreements with the Contractor (Chapter 246-12 WAC).
Provider Credentialing. The Contractor shall be responsible for Credentialing and re-Credentialing its Providers.
Provider Credentialing. Provider agrees that he/she/it meets all applicable Anthem credentialing standards and any other applicable standards of participation for Networks in which Provider participates. A description of the credentialing program or applicable standards of participation, including any applicable accreditation requirements, is set forth in the provider manual(s).
Provider Credentialing. The Contractor must have written policies and procedures for credentialing and recredentialing providers who have signed contracts or participation agreements with the Contractor.
Provider Credentialing. The Contractor’s policies and procedures shall follow the State’s requirements related to the credentialing and re-credentialing of Health Care Professionals who have signed contracts or participation agreements with the Contractor (Chapter 246-12 WAC). The Contractor’s policies and procedures shall ensure compliance with requirements described in this section. The Contractor shall verify that all Subcontractors meet the licensure and certification requirements as established by state and federal statute, administrative code, or as directed in this Contract. The Contractor shall recognize providers operating under the license of a licensed or certified agency. The Contract shall verify that DCRs are authorized as such by the county authorities.
