Credentialing and Re-Credentialing. The Contractor shall credential Providers, except as provided in Section 2.8.8.4, in accordance with NCQA credentialing standards as well as applicable HFS, DHS, DoA, Illinois Department of Insurance and federal requirements. Re-credentialing shall occur every three (3) years. At re-credentialing and on a continuing basis, the Contractor shall verify minimum credentialing requirements and monitor Enrollee Complaints and Appeals, quality of care and quality of service events, and medical record review.
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Credentialing and Re-Credentialing. The Contractor shall credential Providers, except as provided in Section 2.8.8.45.7.5, in accordance with NCQA National Committee for Quality Assurance (NCQA) credentialing standards as well as applicable HFS, DHS, DoA, Illinois Department of Insurance and federal requirements. Re-credentialing shall occur every three (3) years. At re-re- credentialing and on a continuing basis, the Contractor shall verify minimum credentialing requirements and monitor Enrollee Complaints and Appeals, quality of care and quality of service events, and medical record review.
Appears in 3 contracts
Samples: Contract for Health Services, Contract for Health Services, Contract for Health Services
Credentialing and Re-Credentialing. The Contractor shall credential Providers, except as provided in Section 2.8.8.42.8.10.3, in accordance with NCQA credentialing standards as well as applicable HFS, DHS, DoA, Illinois Department of Insurance and federal requirements. Re-credentialing shall occur every three (3) years. At re-credentialing and on a continuing basis, the Contractor shall verify minimum credentialing requirements and monitor Enrollee Complaints and Appeals, quality of care and quality of service events, and medical record review.
Appears in 1 contract
Samples: Contract
Credentialing and Re-Credentialing. The Contractor shall credential Providers, except as provided in Section 2.8.8.4, Providers in accordance with NCQA credentialing standards as well as applicable HFS, DHS, DoAIDoA, Illinois Department of Insurance Insurance, and federal requirements. Re-Re- credentialing shall occur every three (3) years. At re-credentialing and on a continuing basis, the Contractor shall verify minimum credentialing requirements and monitor Enrollee Complaints and Appeals, quality of quality-of-care and quality of quality-of- service events, and medical record review.. Contractor shall document its process for credentialing and re-credentialing Providers.ββ
Appears in 1 contract
Samples: State of Illinois Contract
