Recredentialing definition

Recredentialing or being “recredentialed” means the
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Recredentialing means to confirm that a participating provider is in good standing by a health insurer or its designee and does not require submitting an application or going through a contracting and loading process.
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Recredentialing means the process by which a credentials verification entity verifies the credentials of a health care practitioner whose core credentials data, including all corrections, updates, and modifications thereto, are currently on file with the entity.
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Examples of Recredentialing in a sentence

  • Recredentialing must be completed within 36 months of prior credentialing or recredentialing activity (as required by CMS & DMHC).

  • The contract must address the provider's obligation to maintain licensure, accreditation, and credentials sufficient to meet the PHP's network participation requirements as outlined in the PHP’s Credentialing and Re-credentialing Policy and to notify the PHP of changes in the status of any information relating to the provider's professional credentials.

  • The Contractor shall conduct Credentialing and Recredentialing in compliance with National Committee for Quality Assurance standards (NCQA), KRS 205.560(12), 907 KAR 1:672 or other applicable state regulations and federal law.

  • The Contractor must adhere to all requirements based on the most current version of NCQA Standards and Guidelines for the Accreditation of MCOs. The standards categories include: Quality Management and Improvement, Standards for Utilization Management, Standards for Credentialing and Recredentialing, Standards for Members’ Rights and Responsibilities, Healthcare Effectiveness Data and Information Set (HEDIS) measures required for credentialing (Medicaid products), and CAHPS survey.

  • Detailed documentation and scope of the Credentialing and Recredentialing process is contained in Appendix J.

  • Recredentialing activity that changes the status of Marketing personnel shall be submitted to the Department as changes occur.

  • At any time, but at least annually, United will audit records and documents related to the activities performed under this Addendum, including but not limited to Vendor’s Credentialing and Recredentialing files.

  • United’s policy for Credentialing and Recredentialing of Practitioners and Components.

  • Blue Shield shall be entitled to conduct audits of Group’s compliance with the criteria and standards of Delegated Credentialing and Recredentialing.

  • United may unilaterally change its Credentialing and Recredentialing database requirements by providing thirty (30) days advance notice, in an electronic format, to Vendor of the changes and their effective date.


More Definitions of Recredentialing

Recredentialing means the verification and reverification of all education, licenses, certificates, insurance and liability or claims history to support the qualifications of any Healthcare Provider.
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Recredentialing means a the process undertaken for a
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Related to Recredentialing

  • Credentialing means the process of assessing and validating the qualifications of a provider applying to be approved by a contracting entity to provide basic health care services, specialty health care services, or supplemental health care services to enrollees.

  • Credentials means the cab card and plate issued in accordance with the plan.

  • Credential means a valid credential, life diploma, permit, or document in special education or pupil personnel services issued by, or under the jurisdiction of, the State Board of Education if issued prior to 1970 or the California Commission on Teacher Credentialing, which entitles the holder thereof to perform services for which certification qualifications are required as defined in Title 5 of the California Code of Regulations section 3001(g).

  • Audiology means the care and services provided by a licensed audiologist as set forth in the member state’s statutes and rules.

  • Specialist Physician means a licensed physician who qualifies as an attending physician and who examines a patient at the request of the attending physician or authorized nurse practitioner to aid in evaluation of disability, diagnosis, or provide temporary specialized treatment. A specialist physician may provide specialized treatment for the compensable injury or illness and give advice or an opinion regarding the treatment being rendered, or considered, for a patient’s compensable injury.