Provider Qualifications. 1) The provider must be a licensed Community Based Residential Facility (CBRF).
Provider Qualifications. 4.1 Provider states it consists of health care providers who:
Provider Qualifications. The CHC-MCO may only include Providers in its Network that meet the minimum qualification requirements established by the Department. The CHC-MCO must credential Providers in accordance with the credentialing framework provided by the Department.
Provider Qualifications. Provider shall remain, for the duration of the contract, a qualified firm, and CCPS reserves the right to investigate as such. The investigation may include the submittal of qualifications of Provider to include, but not be limited to: • Organization Description / Acknowledgement of Business Type • Updated Licensure/Certificates and any License Sanction information • References • Financial Information / Bank Statements / Statement of Qualifications • Updated legal action information • Qualifications of Administrative Staff • Qualifications of Employees and Site Staff Request for any information will be made in writing and shall be submitted by Provider within five (5) business days.
Provider Qualifications. 4.6.8.1 The FMA shall verify that all potential providers meet all applicable qualifications prior to delivering services.
Provider Qualifications. 9.3.1 The following requirements apply to specific Providers in the Contractor’s Network:
Provider Qualifications. Provider shall be licensed to practice dentistry in the State and shall maintain good professional standing at all times. Evidence of such licensure shall be submitted to MCNA upon request. Finally, Provider shall be a duly qualified provider under the Medicaid program of the State.
Provider Qualifications. Iowa Medicaid Enterprise shall authorize a team of health care professionals comprised of a Lead Entity and a network of IHH providers to deliver Health Home services to members with SPMI. The Lead Entity of the IHH is responsible entity signing this agreement on behalf of the entire team of health care professionals.
Provider Qualifications. The provider must be a licensed Community Based Residential Facility (CBRF). The provider must be experienced with at least 5 years as a community based provider of non-institutional sub-acute psychiatric services. DQA certification as an Outpatient Mental Health clinic is required. The staffing plan shall include the following positions: Director Clinic Coordinator Community Recovery Specialist Peer Recovery Specialist Mental Health Professional Registered Nurse Advanced Practice Nurse Prescriber Medical Director Other professional and/or para-professional staff as required to meet the needs of the members. Certified Peer Specialist Services The HMO may elect to provide an enhanced behavioral health benefit to eligible members through the use of Certified Peer Specialist providers. This benefit is available for BadgerCare Plus and/or Medicaid SSI HMO enrolled adults (18 years and older) with a mental health and/or substance abuse diagnosis, especially members with a co-morbid diagnosis, who are at risk of hospitalization or who may have been hospitalized. Peer Specialists will be supervised by the HMO rendering provider, who must be a qualified mental health professional. Peer Specialists will be certified and trained by the Department’s Division of Care and Treatment Services (DCTS). DTCS maintains oversight of the training, certification and supervision requirements for peer specialist providers eligible for providing this benefit to HMO members. Peer specialist services will be billed under their supervising clinician’s NPI, using HCPCS code H0038 – Self-help/peer services. Up to 16 units may be billed per week. A unit is 15 minutes. Travel time to and from the member visits may not be billed separately, this time considered covered within the direct time reimbursement.
Provider Qualifications. Provider agrees to maintain a current license to practice in the Service Area, will maintain a current narcotics license issued by the Federal Drug Enforcement Administration if a current narcotics license is necessary for the Provider’s practice, and, unless waived in writing by the Health Plan, will maintain medical staff membership and clinical privileges in good standing at a Plan Facility. Provider represents that the Provider has not been excluded from participation in any governmental health care program, including the Medicare and Medicaid Programs. Provider will notify the Health Plan within seven (7) days of any suspension, revocation or restriction of the Provider’s license to practice or prescribe or administer controlled substances, and of any exclusion from participation in governmental healthcare programs. Provider’s failure to notify the Health Plan of any such action within seven (7) days of the action shall constitute breach of a material term of this Agreement. Provider has legal basis of operation in the State of New Mexico.
