Common use of Re-credentialing Clause in Contracts

Re-credentialing. 24 a. CONTRACTOR shall update, verify and review all pertinent provider credentialing 25 information and qualifications, and assess the provider’s performance over the previous three (3) years. 26 b. CONTRACTOR shall identify and evaluate any changes in the provider’s licensure, 27 clinical privileges, training, experience, current competence, or health status that may affect the 28 provider’s ability to perform the services he or she is providing to members. 29 c. In order to determine whether to re-approve the provider’s participation in 30 CONTRACTOR’s network, CONTRACTOR shall, in addition to updating credentialing information, 31 examine the provider’s clinical competence, examine QI, review patient complaints, and conduct site 32 visits when appropriate, in accordance with CONTRACTOR’s site audit policy, a copy of which shall 33 be provided to ADMINISTRATOR upon request. 34 d. CONTRACTOR shall provide to COUNTY the names of providers denied 35 participation in CONTRACTOR’s Provider Network and the reason for the denial upon request.

Re-credentialing. 24 19 a. CONTRACTOR shall update, verify and review all pertinent provider credentialing 25 20 information and qualifications, and assess the provider’s performance over the previous three (3) years. 26 21 b. CONTRACTOR shall identify and evaluate any changes in the provider’s licensure, 27 22 clinical privileges, training, experience, current competence, or health status that may affect the 28 23 provider’s ability to perform the services he or she is providing to members. 29 24 c. In order to determine whether to re-approve the provider’s participation in 30 25 CONTRACTOR’s network, CONTRACTOR shall, in addition to updating credentialing information, 31 26 examine the provider’s clinical competence, examine QI, review patient complaints, and conduct site 32 27 visits when appropriate, in accordance with CONTRACTOR’s site audit policy, a copy of which shall 33 28 be provided to ADMINISTRATOR upon request. 34 29 d. CONTRACTOR shall provide to COUNTY the names of providers denied 35 30 participation in CONTRACTOR’s Provider Network and the reason for the denial upon request.

Re-credentialing. 24 32 a. CONTRACTOR shall update, verify and review all pertinent provider credentialing 25 33 information and qualifications, and assess the provider’s performance over the previous three (3) years. 26 34 b. CONTRACTOR shall identify and evaluate any changes in the provider’s licensure, 27 35 clinical privileges, training, experience, current competence, or health status that may affect the 28 36 provider’s ability to perform the services he or she is providing to members. 29 37 c. In order to determine whether to re-approve the provider’s participation in 30 1 CONTRACTOR’s network, CONTRACTOR shall, in addition to updating credentialing information, 31 2 examine the provider’s clinical competence, examine QI, review patient complaints, and conduct site 32 3 visits when appropriate, in accordance with CONTRACTOR’s site audit policy, a copy of which shall 33 4 be provided to ADMINISTRATOR upon request. 34 5 d. CONTRACTOR shall provide to COUNTY the names of providers denied 35 6 participation in CONTRACTOR’s Provider Network and the reason for the denial upon request.

Re-credentialing. 24 7 a. CONTRACTOR shall update, verify and review all pertinent provider credentialing 25 8 information and qualifications, and assess the provider’s performance over the previous three (3) years. 26 9 b. CONTRACTOR shall identify and evaluate any changes in the provider’s licensure, 27 10 clinical privileges, training, experience, current competence, or health status that may affect the 28 11 provider’s ability to perform the services he or she is providing to members. 29 12 c. In order to determine whether to re-approve the provider’s participation in 30 13 CONTRACTOR’s network, CONTRACTOR shall, in addition to updating credentialing information, 31 14 examine the provider’s clinical competence, examine QI, review patient complaints, and conduct site 32 15 visits when appropriate, in accordance with CONTRACTOR’s site audit policy, a copy of which shall 33 16 be provided to ADMINISTRATOR upon request. 34 17 d. CONTRACTOR shall provide to COUNTY the names of providers denied 35 18 participation in CONTRACTOR’s Provider Network and the reason for the denial upon request.