ACCESS, AUDIT AND OVERSIGHT. Delegate agrees that it shall:
2.1 At least annually, or more frequently if deemed necessary by Delegator, and then upon not less than ten (10) business days prior notice, or such shorter notice as may be imposed on Delegator by a federal or state regulatory agency or Accreditation Organization, allow Delegator, its designee, and any state or federal entity or Accreditation Organization to access all credentialing/recredentialing documentation, processes, policies, systems, and credentialing/ recredentialing files in order to perform an audit review of the Delegate’s credentialing and recredentialing performance/compliance under this Credentialing Attachment. This includes, but is not limited to, a review of any credentialing and/or recredentialing files, credentialing and recredentialing policies and procedures, and committee meeting minutes that have been approved by the Delegate’s credentialing committee. Delegator will provide at least a ten (10) business days notification on annual audits. The notification for state or federal entity or Accreditation Organization audits will depend on the timeframe imposed on Delegator by state or federal entity or Accreditation Organization. This provision will survive the termination of this Credentialing Attachment for a period of one full credentialing or recredentialing cycle. In-person or telephonic / virtual meetings with participation of both Delegator and the Delegate will be held to discuss results of audits or reports on an as needed basis.
2.2 Agree that all elements of credentialing and/or recredentialing activities and all functions delegated hereunder require a minimum of ninety-five percent (95%) compliance. Failure to meet compliance requirements described above will result minimally in a Corrective Action Plan (“CAP”), and may result in revocation of some or all of the delegated activities.
a. A CAP issued by Delegator will include the issues identified, actions which are required to be taken, submission due dates and methods of re-evaluation, and may also include without limitation, intensifying the frequency and number of on-site audits, the temporary loss of some or all delegated rights under this Credentialing Attachment, or the termination of the Addendum.
b. Delegate will have fourteen (14) calendar days to provide a written response describing how they will meet the requirements found to be noncompliant including prospective date of compliance.
c. If Delegator receives information through its ...
ACCESS, AUDIT AND OVERSIGHT. Delegate agrees that it shall:
2.1 At least annually, or more frequently if deemed necessary by Delegator, and then upon not less than ten (10) business days prior notice, or such shorter notice as may be imposed on Delegator by a federal or state regulatory agency or Accreditation Organization, allow Delegator,its designee, and any state or federal entity or Accreditation Organization to access all CCM documentation, processes, policies, systems, and files in order to perform an audit review of the Delegate’s policies and procedures, program plan, QI/UM Committee meeting minutes that have been approved by the Delegate’s QI/UM Committee, and Delegate’s performance/compliance under this CCM Attachment. In-person or telephonic/virtual meetings with participation of both Delegator and the Delegate will be held to discuss results of audits or reports on an as needed basis.
2.2 Submit to Delegator, with respect to delegated functions, all required reports and analyses, as indicated in TABLE 2, which is attached and hereby incorporated by reference, along with identified problems, corrective actions initiated, and outcomes.
a. All reports and subsections of reports must be specific to line of business and offering Delegator’s affiliate, and all reporting formats must be pre-approved by Delegator.
b. The analysis of data must address identified opportunities for improvement with dates that documented interventions were implemented. The next scheduled report must address follow up activities, outcomes and/or status.
c. Delegate agrees to provide any and all reports requested by Delegator within timeframes identified by Delegator to ensure Delegator meets all new and revised Delegator, CMS, Federal, State and Accreditation Organization reporting requirements.
2.3 Acknowledge and agree that Delegator maintains the ultimate responsibility for the sufficiency and appropriateness of the DM programs and retains the right to implement a Corrective Action Plan (CAP), suspend or terminate any of this CCM Attachment at any time Delegate fails to meet or comply with Delegator’s policies, procedures, and program requirements and all applicable state and federal laws, rules and regulations and Accreditation Organization requirements.
2.4 Should the Delegate be placed on a CAP, the Delegate will have fourteen (14) calendar days to provide a written response describing how they will meet the requirements found to be noncompliant including prospective date of compliance.
2.5 Dele...
ACCESS, AUDIT AND OVERSIGHT. Delegate agrees that it shall:
2.1 At least annually, or more frequently if deemed necessary by Delegator, and then upon not less than ten (10) business days prior notice, or such shorter notice as may be imposed on Delegator by a federal or state regulatory agency or Accreditation Organization, allow Delegator, its designee, and any state or federal entity or Accreditation Organization to access all DM documentation, processes, policies, systems, and files in order to perform an audit review of the Delegate’s policies and procedures, program plan, QI/UM Committee meeting minutes that have been approved by the Delegate’s QI/UM Committee, and Delegate’s performance/compliance under this DM Attachment. In-person or telephonic/virtual meetings with participation of both Delegator and the Delegate will be held to discuss results of audits or reports on an as needed basis.
2.2 Submit to Delegator, with respect to delegated functions, all required reports and analyses, as indicated in TABLE 2, which is attached and hereby incorporated by reference, along with identified problems, corrective actions initiated, and outcomes.
ACCESS, AUDIT AND OVERSIGHT. Delegate agrees that it shall:
2.1 At least annually, or more frequently if deemed necessary by Delegator, and then upon not less than ten (10) business days prior notice, allow access to all quality program documentation, processes, policies, systems, and files to permit Delegator, or its designee, to perform an audit review of the Delegate’s policies and procedures, program plan, committee meeting minutes that have been approved by the Delegate’s Quality Improvement Committee (QI Committee), and Delegate’s performance/compliance under this Attachment.
2.2 Represent and warrant that it oversees all delegated services in accordance with its policies and procedures and that such policies and procedures are compliant with Delegator’s policies and procedures, state and federal laws, rules and regulations, and all Accreditation Organization standards to which Delegator is subject, and acknowledges and agree that Delegate’s quality improvement policies and procedures are subject to Delegator’s review and written approval.
