Complaints about a Credentialed Provider Sample Clauses

Complaints about a Credentialed Provider. Provider agrees to assist Health Plan with investigation of complaints received about one of its Credentialed Provider sites, including site visit as indicated, and in accordance with Health Plan policies and procedures. Health Plan monitors member complaints about Credentialed Provider sites on an ongoing basis. Health Plan will request office site visits for those Credentialed Providers who meet Health Plan complaint thresholds for concerns about physical accessibility, appearance, adequacy of exam room/waiting room space, office procedures, etc. per National Committee for Quality Assurance (“NCQA”) requirements. When a member complaint is received about the site of a Credentialed Provider, Health Plan will forward the complaint and a request for an onsite visit to Provider within two business days of receipt of the complaint by Health Plan. Provider will have 30 calendar days from receipt of the notification to conduct a site visit at involved Credentialed Provider site and report findings to Health Plan. If office does not receive score of at least 80%, Provider must initiate a corrective action plan (“CAP”) and perform a follow-up site visit within three months to evaluate whether the deficiencies in the CAP are resolved. Failure to comply with the terms of the CAP may result in probation, suspension or immediate termination of involved Credentialed Provider. Office site visits may be required in additional circumstances per State contract. Provider shall comply with all or both, whichever is stricter. The Health Plan’s timeframe for resolution shall not exceed 60 days from receipt of the complaint. The Health Plan monitors complaints and adverse events on an ongoing basis and at recredentialing.
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