Common use of Credentialing and Re-Credentialing Policies and Procedures Clause in Contracts

Credentialing and Re-Credentialing Policies and Procedures. (A) Pursuant to 42 CFR 438.214(b)(2), the Contractor shall have written policies and procedures for credentialing potential Participating Providers and re-credentialing Participating Providers. The Contractor’s written policies and procedures shall follow the Department’s policies that require: (1) Participating Provider completion of Contractor written applications; (2) Procedures for assuring that potential and current Participating Providers are appropriately credentialed, (for example, that the Provider has a current license and/or accreditation as applicable and is in good standing with the licensing board and/or accreditation as applicable); (3) Primary source verification of licensure and disciplinary status by the State of Utah and other States; (4) Procedures for viewing public records for any adverse actions, including sanctioning and/or federal debarment, suspension, or exclusion.

Credentialing and Re-Credentialing Policies and Procedures. (A) Pursuant to 42 CFR 438.214(b)(2), the Contractor shall have written policies and procedures for credentialing potential Participating Network Providers and re-credentialing Participating Network Providers. The Contractor’s written policies and procedures shall follow the Department’s policies that require: (1) Participating Network Provider completion of Contractor written applications; (2) Procedures for assuring that potential and current Participating Network Providers are appropriately credentialed, (for example, that the Provider has a current license and/or accreditation as applicable and is in good standing with the licensing board and/or accreditation as applicable); (3) Primary source verification of licensure and disciplinary status by the State of Utah and other States; (4) Procedures for viewing public records for any adverse actions, including sanctioning and/or federal debarment, suspension, or exclusion.