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:
2.7.3.1. Continue to be responsible for required Credentialing activities throughout the transition to a centralized entity or entities.
2.7.3.2. 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 Provider Dispute processes.
2.7.3.3. Conduct reassessments to determine if corrective action yields intended results.
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:
2.8.3.1. Continue to be responsible for required credentialing activities throughout the transition to a centralized entity or entities.
2.8.3.2. 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.
2.8.3.3. Conduct reassessments to determine if corrective action yields intended results.
Centralized Provider Enrollment and Credentialing a) The Department, or Department designated Vendor, will implement a CCRP with the following features:
1. The Department, or Department designated Vendor, shall collect information and verify credentials, through a centralized Credentialing process for all providers currently enrolled or seeking to enroll in the North Carolina’s Medicaid program.
A. The information shall be collected, verified, and maintained according to the Department’s Medicaid Enrollment/Credentialing criteria as required to participate as a Medicaid Enrolled provider.
B. The Department may, at its option, contract with a Vendor to provide any aspect of provider data management and/or credentials verification services necessary for operation of the CCRP.
2. The Department shall apply the Credentialing policies to any providers who furnish, order, prescribe, refer or certify eligibility for the Medicaid services, including all providers that must be credentialed under Credentialing standards established by a nationally-recognized accrediting body. 42 C.F.R. § 438.602(b).
3. The process and information requirements shall meet the most current data and processing standards for a Credentialing process for an accredited health plan with accreditation from the selected, nationally recognized accrediting organization, and shall also meet the standards found in 42 C.F.R. Part 455 Subparts B and E. The Department has selected the National Committee for Quality Assurance as the Plan accrediting organization.
A. The applicable data and processing standards shall be consistent with current waivers or exceptions as outlined in agreements with the National Committee for Quality Assurance, and in effect consistent with the effectiveness of the waiver/exceptions.
4. Providers will use a single, electronic application to submit information to be verified and screened to become a Medicaid enrolled provider, with the application serving for enrollment as a Medicaid Fee-for-Serviceprovider as well as a Medicaid Managed Care Provider.
A. The Department shall not mandate Medicaid Managed Care providers enrolled with the State participate in the State Medicaid Fee-for-Service program.
5. Providers will be reverified and recredentialed as permitted by the Department in the Contract.
6. The CFSP shall use its Provider Credentialing and Re-credentialing Policy to decide whether to contract with a Medicaid Enrolled provider in accordance with the standards contained in this Policy.
7. The Department, or its desi...
Centralized Provider Enrollment and Credentialing. The Department, or Department designated vendor, will implement a Centralized Credentialing and Re-credentialing Process (CCRP) with the following features:
