Common use of Credentialing and Re-Credentialing Clause in Contracts

Credentialing and Re-Credentialing. 20.1 Contractors must follow the uniform process for credentialing and re-credentialing of network providers established by the MHP and pursuant to 42 C.F.R. § 438.214. The Contractor, at minimum, must verify and document specified items listed on the credentialing and re-credentialing procedure for all of its providers through a primary source and must verify and document all the specified items on the credentialing and re-credentialing procedure through a non-primary source. 20.2 Upon request, contracted agencies/individuals must demonstrate to the MHP that each of its providers are qualified in accordance with current legal, professional, and technical standards, and that they are appropriately licensed, registered, waivered, and/or certified. 20.3 Contractors must not employ or subcontract with providers excluded from participation in Federal health care programs, including Medi-Cal/Medicaid. See CERTIFICATION OF NON-EXCLUSION OR SUSPENSION FROM PARTICIPATION IN FEDERAL HEALTH CARE PROGRAM. 20.4 Contractors shall ensure that all of their network providers, delivering covered services, sign and date an attestation statement, which must be developed by each Contractor, in which each provider attests to the following: 20.4.1 Any limitations or inabilities that affect the provider’s ability to perform any of the position’s essential functions, with or without accommodation; 20.4.2 A history of loss of license or felony convictions; 20.4.3 A history of loss or limitation of privileges or disciplinary activity; 20.4.4 A lack of present illegal drug use; and 20.4.5 The application’s accuracy and completeness The Contractor must file and keep track of attestation statements for all of their providers and must make those available to the MHP upon request at any time. 20.5 Contractors are required to sign an annual attestation statement at the time of contract renewal in which they will attest that they will follow BHRS’s Credentialing Policy and DHCS Information Notice 18-019 and ensure that all of their rendering providers are credentialed as per established guidelines. 20.6 Contractors are required to verify and document at a minimum every three years that each network provider that delivers covered services continues to possess valid credentials, including verification of each of the credentialing requirements as per the MHP’s uniform process for credentialing and re-credentialing. If any of the requirements are not up-to-date, updated information should be obtained from network providers to complete the re-credentialing process. 20.7 Contractors must ensure that they follow the MHP’s uniform process for credentialing and re-credentialing, including disciplinary actions such as reducing, suspending, or terminating provider’s privileges. Failure to comply with specified requirements can result in suspension or termination of a provider. 20.8 Contractor shall ensure that all staff and subcontractors providing services will have a valid professional license to practice the contracted services. This includes implementing procedures of professional license checks, credentialing and re-credentialing, monitoring limitations and expiration of licenses, and ensuring that all providers have a current National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES). Contractor shall provide evidence of these completed verifications when requested by County, State Department of Health Care Services or the US Department of Health & Human Services.

Credentialing and Re-Credentialing. 20.1 Contractors must follow the uniform process for credentialing and re-credentialing of network providers established by the MHP and pursuant to 42 C.F.R. § 438.214. The Contractor, at minimum, must verify and document specified items listed on the credentialing and re-credentialing procedure for all of its providers through a primary source and must verify and document all the specified items on the credentialing and re-credentialing procedure through a non-non- primary source. 20.2 Upon request, contracted agencies/individuals must demonstrate to the MHP that each of its providers are qualified in accordance with current legal, professional, and technical standards, and that they are appropriately licensed, registered, waivered, and/or certified. 20.3 Contractors must not employ or subcontract with providers excluded from participation in Federal health care programs, including Medi-Cal/Medicaid. See CERTIFICATION OF NON-EXCLUSION OR SUSPENSION FROM PARTICIPATION IN FEDERAL HEALTH CARE PROGRAM. 20.4 Contractors shall ensure that all of their network providers, delivering covered services, sign and date an attestation statement, which must be developed by each Contractor, in which each provider attests to the following: 20.4.1 Any limitations or inabilities that affect the provider’s ability to perform any of the position’s essential functions, with or without accommodation; 20.4.2 A history of loss of license or felony convictions; 20.4.3 A history of loss or limitation of privileges or disciplinary activity; 20.4.4 A lack of present illegal drug use; and 20.4.5 The application’s accuracy and completeness The Contractor must file and keep track of attestation statements for all of their providers and must make those available to the MHP upon request at any time. 20.5 Contractors are required to sign an annual attestation statement at the time of contract renewal in which they will attest that they will follow BHRS’s Credentialing Policy and DHCS Information Notice 18-019 and ensure that all of their rendering providers are credentialed as per established guidelines. 20.6 Contractors are required to verify and document at a minimum every three years that each network provider that delivers covered services continues to possess valid credentials, including verification of each of the credentialing requirements as per the MHP’s uniform process for credentialing and re-credentialing. If any of the requirements are not up-to-date, updated information should be obtained from network providers to complete the re-credentialing process. 20.7 Contractors must ensure that they follow the MHP’s uniform process for credentialing and re-credentialing, including disciplinary actions such as reducing, suspending, or terminating provider’s privileges. Failure to comply with specified requirements can result in suspension or termination of a provider. 20.8 Contractor shall ensure that all staff and subcontractors providing services will have a valid professional license to practice the contracted services. This includes implementing procedures of professional license checks, credentialing and re-credentialing, monitoring limitations and expiration of licenses, and ensuring that all providers have a current National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES). Contractor shall provide evidence of these completed verifications when requested by County, State Department of Health Care Services or the US Department of Health & Human Services.