Centralized Provider Enrollment and Credentialing Sample Clauses

Centralized Provider Enrollment and Credentialing. The Department may partner with external entities for the purposes of centralizing all South Carolina Medicaid Network Provider enrollments and Credentialing functions. These functions include, but are not limited to, receiving completed applications, attestations, and primary source verification documents, and conducting annual Provider site visits to ensure compliance with Medicaid requirements. Once the Department signs a contract with an entity, the CONTRACTOR will receive notice and be required to make said entity responsible for its Credentialing and re-Credentialing process within one hundred and twenty (120) Days of notice from the Department. The CONTRACTOR shall:
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Centralized Provider Enrollment and Credentialing. The Department intends to partner with external entities for the purposes of centralizing all provider enrollments and credentialing functions. These functions include, but are not limited to receiving completed applications, attestations and primary source verification documents and conducting annual provider site visits to ensure compliance with Medicaid requirements. Once the Department signs a contract with an entity, the CONTRACTOR will receive notice and be required to make said entity responsible for its credentialing and re-credentialing process within one hundred and twenty (120) days of notice from the Department. The CONTRACTOR shall:
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Centralized Provider Enrollment and Credentialing. The Department intends to partner with external entities for the purposes of centralizing all provider enrollments and credentialing functions. These functions include, but are not limited to receiving completed applications, attestations and primary source verification documents and conducting annual provider site visits to ensure compliance with Medicaid requirements. Once the Department signs a contract with an entity, the CONTRACTOR will receive notice and be required to make said entity responsible for its credentialing and re-credentialing process within one hundred and twenty (120) days of notice from the Department. The CONTRACTOR shall: Continue to be responsible for required credentialing activities throughout the transition to a centralized entity or entities. Have procedures for informing network providers of identified deficiencies, conducting ongoing monitoring of corrective actions, and taking appropriate follow-up actions, such as instituting progressive sanctions and appeal processes. Conduct reassessments to determine if corrective action yields intended results.
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Centralized Provider Enrollment and Credentialing i. The Department, or Department designated vendor, will implement a Centralized Credentialing and Re-credentialing Process (CCRP) with the following features:
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Related to Centralized Provider Enrollment and Credentialing

  • 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 Selection To the extent applicable to Provider in performance of the Agreement, Provider shall comply with 42 CFR 438.214, as may be amended from time to time, which includes, but is not limited to the selection and retention of providers, credentialing and recredentialing requirements and nondiscrimination. If Subcontractor and/or Health Plan delegate credentialing to Provider, Subcontractor and/or Health Plan will provide monitoring and oversight and Provider shall ensure that all licensed medical professionals are credentialed in accordance with Health Plan’s and the State Contract’s credentialing requirements.

  • Credentialing The Provider will maintain written documentation confirming that each individual providing services under this agreement has and maintains the requisite credentials. Any change in status regarding any credentialing requirements must be reported in writing, by the Provider to the Department's Credentialing Contracted Agent, within thirty days.

  • Provider Network The Panel of health service Providers with which the Contractor contracts for the provision of covered services to Members and Out-of-network Providers administering services to Members.

  • Medical Verification The Town may require medical verification of an employee’s absence if the Town perceives the employee is abusing sick leave or has used an excessive amount of sick leave. The Town may require medical verification of an employee’s absence to verify that the employee is able to return to work with or without restrictions.

  • OGS Centralized Contract Terms and Conditions have been renumbered as depicted in the following chart: Current Amended Section Title 4.25 4.26 Severability 4.26 4.27 Entire Agreement

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Provider Services The Contractor’s system shall collect, process, and maintain current and historical data on program providers. This information shall be accessible to all parts of the MCMIS for editing and reporting.

  • Restricted Use By Outsourcers / Facilities Management, Service Bureaus or Other Third Parties Outsourcers, facilities management or service bureaus retained by Licensee shall have the right to use the Product to maintain Licensee’s business operations, including data processing, for the time period that they are engaged in such activities, provided that: 1) Licensee gives notice to Contractor of such party, site of intended use of the Product, and means of access; and 2) such party has executed, or agrees to execute, the Product manufacturer’s standard nondisclosure or restricted use agreement which executed agreement shall be accepted by the Contractor (“Non-Disclosure Agreement”); and 3) if such party is engaged in the business of facility management, outsourcing, service bureau or other services, such third party will maintain a logical or physical partition within its computer system so as to restrict use and access to the program to that portion solely dedicated to beneficial use for Licensee. In no event shall Licensee assume any liability for third party’s compliance with the terms of the Non-Disclosure Agreement, nor shall the Non-Disclosure Agreement create or impose any liabilities on the State or Licensee. Any third party with whom a Licensee has a relationship for a state function or business operation, shall have the temporary right to use Product (e.g., JAVA Applets), provided that such use shall be limited to the time period during which the third party is using the Product for the function or business activity.

  • Provider Manual The Provider Manual shall be a comprehensive online reference tool for the Provider and staff regarding, but not limited to, administrative, prior authorization, and referral processes, claims and encounter submission processes, continuity of care requirements, and plan benefits. The Provider Manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs and Enrollee rights.

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